Hardeeville Community Transformation Foundation Business Grant
Please fill out the following questions as accurately and asthoroughly as possible in the space provided.
Organization Name
Type of Organization
Employee Identification Number
Does your business have a business license with the City of Hardeeville?
Yes
No
Business License Number
Address Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Website
Owner's Name
First Name
Last Name
Owner's Phone Number
-
Area Code
Phone Number
Owner's Email
example@example.com
Contact Person Name
First Name
Last Name
Contact Person Title
Contact Person Phone
-
Area Code
Phone Number
Contact Person Email
example@example.com
What is the mission of your organization?
Number of total employees
Number of full-time employees
Number of part-time employees
Please upload a copy of W-9 form
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Please upload a copy of the business 2019, 2020, and 2021 income statements.
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Please upload a copy of the business 2019 and 2020 tax returns, provide 2021 tax returns if filed.
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Please upload an image of the location of the organization
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Please upload an image of the current employees in front of the business
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Was your organization affected by the COVID-19 pandemic?
Yes
No
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Hardeeville Community Transformation Foundation Business Grant
COVID-19 Impacts
Please explain how your business was impacted by the COVID-19 pandemic.
Please explain how your employees were impacted by the COVID-19 pandemic.
Did you have any lay-offs of employees during the COVID-19 pandemic?
Yes
No
If yes, how many people were laid off and for how long?
Did you have to let go of any employees during the COVID-19 pandemic?
Yes
No
If yes, how many people were let go and were any of them rehired?
Do you have any vacancies currently?
Yes
No
If you have any vacancies currently, how many positions are available or needed?
What are your recruitment and marketing strategies for the open or needed positions?
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Hardeeville Community Transformation Business Grant
Grant Details
Does the Program / Project meet one of the listed guidelines established by the American Rescue Plan Act of 2021 (ARPA)?
Yes
No
If so, please select the category in which the Program /Project supports.
Revenue replacement for the provision of government services to the extent of the reduction in revenue due to the COVID-19 public health emergency, relative to revenues collected in the most recent fiscal year prior to the emergency.
COVID-19 expenditures or negative economic impacts ofCOVID-19, including assistance to small businesses, households, and hard-hit industries, and economic recovery.
Premium pay for essential workers.
Premium pay for essential workers.
Please describe the purpose of requesting a business grant through the Hardeeville Community Transformation Foundation.
Amount requested ($)
Where will you use the funds (if granted)
Who will benefit from this Program / Project?
How will this Program / Project be funded in the future?
What are the anticipated outcomes of the Program / Project?
How do you propose to publicly announce the grant award and how will you recognize the grant from the Hardeeville Community Transformation Foundation?
Grant recipients will have the responsibility of providing quarterly reports on the Program / Project. Will your organization have the ability to provide routine reports that shows the detail of the Program /Project and the related expenses?
Yes
No
Total monthly expenses ($)
Annual expenses ($)
Total monthly income from all sources ($)
Annual revenues ($)
Did you have a change in revenues during the COVID-19 pandemic?
Yes
No
Describe any loss or gain of revenues during the COVID-19 pandemic.
How are you helping others during the pandemic?
What other financial relief organizations have you applied to, please identify each source?
Please identify the amount of financial relief received from each organization and what were those funds used for.
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Date Signed
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Month
-
Day
Year
Date
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