City of Humboldt, Kansas

1.	Do you currently own your own business?	Yes No (please skip to Q3)
	If yes, is your business home-based?	Yes (please continue with Q2) No (please skip to Q4)
2.	If home-based, are you interested in expanding your business?	Yes, in your home (see Q2a) Yes, to a location outside your home (see Q2a) No (skip to Q4) Unsure (skip to Q4)
2a.	Will you be expanding in the next:	3-6 months (skip to Q4) Within the next year (skip to Q4) Sometime in the future (skip to Q4) Unsure (skip to Q4)
3.	Do you have an interest in starting/owning a business?	Yes, within the near future Yes, within the next year or two No (please skip to Q4) Unsure
	If yes, what type of business do you plan to begin? (select from drop-down menu)
	Please specify your business:
4.	What type(s) of assistance do you believe someone might need to begin a business? (select multiply entries by holding down the Ctrl key, [or the command key on the Macintosh])
	Please specify other
5.	What type(s) of stores or businesses do you believe are needed in the immediate area?
Please tell us about yourself
6.	Gender	Male Female
7.	Age	Under 18 18-24 25-34 35-44 45-54 55-64 65-70 over 70
8.	Employment Status	Employed Full-time Employed Part-time Unemployed Retired Student
	Please provide us with any comments you might have regarding the proposed incubator facility