1 Start 2 Complete 0% 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 + Date of Business Incorporation MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Year 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 City Postal Code Was your Business Impacted by COVID-19? Yes No How has your organization been impacted by COVID-19 Was your business impacted by the civil uprising/unrest (George Floyd events)? Yes No How has your business been impacted by civil unrest Please describe the purpose of your business or mission statement Please include the target population and any plans for community and stakeholder engagement efforts Summary of Proposal for Development: Project Location Summary of Proposed Project/Work Summary of Proposal for Development: Project Completion Plan Project Budget Download and fill out the project budget document. Attach your project description file below: More informationFiles must be less than 2 MB. Allowed file types: jpg jpeg png html pdf doc docx ppt pptx xls xlsx. Upload Submit
