Survey | Qualtrics Survey Software

Title:

	Mr.
	Mrs.
	Ms.
	Dr.
	Other

Your Name (Last name, First name):

Preferred E-Mail Address:

Preferred Mailing Address:

Preferred Phone Number (including country code):

Kellogg Graduation Year:

Kellogg Program (check one):

	Full-Time Day
	Part-Time
	EMP
	Other

Gender:

	Male
	Female

What generation # are you in the family business?

	1
	2
	3
	4
	5
	6
	Other

Your Nationality:

This is how I am involved in the family business (check all that apply):

	I work in my family's business.
	I am an owner/shareholder in my family's business.
	I am a board member in my family's business.
	Other:

Name(s) of the Family Business(es):

Headquarter location of Family Business (city, state/province, country):

Founding year or acquisition year of the family business:

Company or Family Enterprise website address:

My position/title in the family business is:

Our family enterprise includes the following (check all that apply):

	Family Business(es)
	Family Foundation
	Family Investment Company
	Family Office
	Family Council

Industries in which the family business is involved:

Is any part of your family enterprise(s) publicly listed (check all that apply):

	No
	Yes, in U.S.
	Yes, in other country(ies)

Number of employees in the family business (approximately):

Annual revenues in the family business (check one):

	less than $1 million
	$1-20 million
	$21-50 million
	$51-100 million
	$101-500 million
	$501-999 million
	$1 billion or more

Number of current family owners/shareholders in the family business (check one):

	1
	2-5
	6-10
	11-20
	21 or more

Approximate number of family shareholders expected in 10-15 years:

Total number of directors on the board of the family business (check one):

	5 or fewer
	6
	7
	8
	9
	10
	11
	12
	13

Number of fully independent (non-family, non-employee) directors on the family business board (check one):

	0
	1
	2
	3
	4
	5
	6 or more

We invite you to send us a sample item from your family business, as well as material relating to its history, for our Center's display shelves and archives. Please list what you will be sending us:

This survey information may be shared exclusively with (check all that apply):

	MBA students in the family business course from business owning families who have also completed this survey
	Kellogg Alumni who are also from business owning families and who have also completed this survey
	None of the above