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Contact 1
Business Phone Number
Business Owner Email
Business Website
First Name
Last Name
Company Legal Name
Number of years in operation
0 - 5
5 -10
10 -15
15 +
When was your Business registered with the state?
Employer Identification Number
What is the legal structure of your company?
Sole proprietorship
Limited Liability Company
S Corporation
C Corporation
Nonprofit 501c3
Constituent Info - Individuals
Business Name
Number of employees
Business Address
State/Province
- Select -
City
Postal Code
Was your Business Impacted by COVID-19?
Yes
No
Was your business impacted by the civil uprising/unrest (George Floyd events)?
Yes
No
How has your organization been impacted by COVID-19
Please describe the purpose of your business or mission statement
How has your business been impacted by civil unrest
Please include the target population and any plans for community and stakeholder engagement efforts
Summary of Project Location
Summary of Proposed Project/Work
Summary of Project Completion Plan
Project Budget
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project budget document.
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2 MB limit.
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