Diversity Certification Eligibility Survey First Name * Last Name * Email * Company primary office in: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands Choose all that apply (Hold down SHIFT or CTRL keys to select multiple) * 51% Minority ownership 51% Women ownership 51% Veteran ownership 51% Service-Disabled Veteran ownership 51% Disabled ownership 51% LGBTQ ownership 51% Disadvantaged ownership None of the above Company organized (incorporated, formed) in: * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands Primary unemployment is paid in: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands Primary operations are in: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands Company is an independent business (not part of a larger company) Business meets SBA small business definition for its NAICS code LABEL For reference, visit www.sba.gov Business is not reliant on a single customer or another company Years in operation Business is organized for profit (not a non-profit) Business has filed tax returns Average gross annual sales (add last three years of sales and divide by 3) * Citizenship * US citizen Permanent resident (green card) None of the above Owner(s) state of residency: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia Puerto Rico Guam American Samoa U.S. Virgin Islands Northern Mariana Islands Owner(s) personal net worth less than: * $1.32M $750K $250K Business is currently certified? If certified, by whom? If you are a human seeing this field, please leave it empty.
