Abbott / LISC Supplier Diversity Programs Questionnaire

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Thank you for your interest in LISC’s Supplier Diversity Programs. Based on your initial responses, you may qualify for this Supplier Diversity Program and potential growth capital. LISC is collecting the information in this questionnaire to determine if and how our programs can be of assistance to you. The questionnaire will take about 20 minutes to complete. For business owners with multiple businesses, please answer this questionnaire for one business only.  Before proceeding, LISC recommends that respondents read the FAQ associated with the program you are interested in for more information. Please email SupplierDiversity@lisc.org for questions and troubleshooting.
Eligibility is based on accurate and complete submission of this questionnaire.  Current directors, officers, employees and contractors of LISC or other donor companies and such individuals' family members (spouse, parents, children, grandchildren, great-grandchildren, and spouses of children, grandchildren, and great-grandchildren) may not be eligible to participate in the program.

Privacy: Information provided through this intake process is the responsibility of each applicant and remains confidential. Applicants will not hold LISC or LISC’s respective affiliates, and/or their affiliates’ respective members, partners, officers, employees, and agents liable for any losses, damages, costs, or expenses of any kind relating to the use or the adequacy, accuracy, or completeness of any information loaded in the form. For further information please see LISC’s privacy policy. Data entered on this secure form utilizes Form Assembly. More info.
Self-Assessment Responses









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Business Owner Information





Who will serve as the primary contact for this inquiry to the program?















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Business Information

If none enter "N/A"

If none enter "N/A"


If Applicable






















Enter whole number - No decimals



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Where ownership is based on 51% ownership or more.

For this next section, full-time workers are those who work 35 hours/week or more;  
part-time workers are those who work less than 35 hours/week. 




Enter anticipated dollar amount or N/A if unsure.

Enter anticipated number of months or N/A if unsure.

Enter anticipated dollar amount or N/A if unsure.



Please enter only whole numbers without the dollar sign.


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The next portion of the survey requests socio-economic data. Please provide information based on how you self-identify. 

 

Information provided through this questionnaire process is the responsibility of each applicant. Questionnaire submitted to the portal remain confidential to the general public and any fellow applicants. Applicants will not hold LISC or, its affiliates, members, partners and staff liable for any losses, damages, costs, or expenses, of any kind relating to the use or the adequacy, accuracy, or completeness of any information loaded in the form. 


Link to LISC's Privacy Policy 


Business owners need to be at least 18 years old.



If you identify as more than one race, LISC will report this as “biracial or multiracial” for reporting purposes.





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Final Step: Please review the information below, e-sign and submit your form: 

Thank you for completing your initial intake survey. Please click 'Submit' below to complete your submission. By signing your name and submitting the form below, you confirm that the information provided about you and your business are true in all material respects. 


For general questions, please check the FAQ regularly for updates about the program. For additional questions, please email SupplierDiversity@lisc.org. We are monitoring this email regularly and updating our FAQ accordingly.  


 For data security questions, please review LISC’s Privacy Policy.  

 
For updates on additional resources and programs, visit our webpage or sign up for our newsletter here.  


Please enter your full name

Contact Information