From Side Gig to Legacy — Client Intake Form

Queer Compass Institute

From Side Gig to Legacy
Client Intake Form

This information supports your experience in the program and helps us track participant outcomes and build better programs. All demographic data is kept confidential and reported in aggregate only.

Section 1

Contact + Basics

Full name *

Preferred name / nickname

Pronouns

City and state *

Email address *

Phone number

How did you hear about this program?

Instagram TikTok Email list Referral from a friend or colleague Empower Hour Bloom Social Club event Other

Name of person who referred you (if applicable)

Section 2

Your Business

What is the name of your business or practice?

How would you describe what you do in one sentence?

How long have you been doing this work in any form — paid or unpaid?

Less than 1 year 1–2 years 3–5 years 6–10 years More than 10 years

Which best describes where you are right now?

I have an idea but have not launched yet I have launched but am not making consistent income from it I am making some income but it is not yet sustainable I have a functioning business and want to grow or refine it

What is your current monthly revenue from your business or side work?

$0 $1–$500 $501–$1,500 $1,501–$3,000 $3,001–$5,000 $5,000+

What industry or sector does your work fall in? (select all that apply)

Coaching or consulting Creative arts or media Health and wellness Education or training Community organizing or advocacy Social enterprise or nonprofit Technology Food, hospitality, or events Fashion or beauty Other

Section 3

Pre-Assessment

Rate yourself from 1 (not at all) to 5 (very much) on each of the following.

I have a clear sense of who my ideal client or customer is.

Not at all

Very much

I feel confident talking about my work and what I offer.

Not at all

Very much

I have a defined offer with a set price that I actively promote.

Not at all

Very much

I know how to find and reach potential clients or customers.

Not at all

Very much

I believe my work is worth what I charge or want to charge.

Not at all

Very much

I have a consistent revenue-generating habit or practice in my business.

Not at all

Very much

What is the single biggest thing standing between you and a sustainable income from your work?

What do you most want to walk away from this program with — specifically?

What have you tried before that has not worked, and why do you think that is?

Is there anything about your current situation — personal, financial, or professional — that you want me to know going into this program?

Section 4

Demographics

All data in this section is kept confidential and reported in aggregate only.

Age range

18–24 25–34 35–44 45–54 55–64 65+

Gender identity (select all that apply)

Man Woman Non-binary Genderqueer or genderfluid Transgender Two-spirit Agender Prefer not to answer

Prefer to self-describe:

Sexual orientation (select all that apply)

Gay Lesbian Bisexual Queer Pansexual Same-gender loving Asexual Heterosexual Prefer not to answer

Prefer to self-describe:

Race and ethnicity (select all that apply)

Black or African American Latino/a/x or Hispanic Asian or Pacific Islander Native American or Indigenous Middle Eastern or North African White or European American Multiracial Prefer not to answer

Prefer to self-describe:

Do you identify as a person of color?

Yes No Prefer not to answer

Do you identify as LGBTQ+?

Yes No Prefer not to answer

Do you identify as having a disability (visible or non-visible)?

Yes No Prefer not to answer

Highest level of education completed

Some high school High school diploma or GED Some college Associate degree Bachelor’s degree Graduate or professional degree Prefer not to answer

Current employment status

Self-employed full time Self-employed part time Employed full time — business is a side project Employed part time — business is a side project Unemployed or between positions

Annual household income (approximate)

Under $25,000 $25,000–$49,999 $50,000–$74,999 $75,000–$99,999 $100,000–$149,999 $150,000+ Prefer not to answer

Current location (select all that apply)

Los Angeles County Bay Area or Northern California San Diego County Inland Empire Sacramento area

Outside California — please specify:

Section 5

Consent + Permissions

Your information is kept confidential. Demographic data is used internally in aggregate only and will never be used to identify you individually.

I agree that my information may be used in aggregate to support program development. I understand my individual information will not be shared or identified.

I am open to being contacted in the future about testimonials, case studies, or future program opportunities.

Yes No Maybe — reach out and ask me

Your responses are sent directly and securely to Noris.

You are in.

Your intake form has been received. Look for a confirmation from Noris before the first session.

From Side Gig to Legacy is a program of Queer Compass Institute
norisknows.com | noris@norisknows.com

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From Side Gig to Legacy – Client Intake Form

From Side Gig to LegacyClient Intake Form

Contact + Basics

Your Business

Pre-Assessment

Demographics

Consent + Permissions

You are in.

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From Side Gig to Legacy
Client Intake Form