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COVID-19 Community Assistance Program
Grantee Report Form
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* Indicates required question
Email
*
Your email
Date
*
MM
/
DD
/
YYYY
Business Name
*
Your answer
Report Prepared by
*
Your answer
Phone Number
*
Your answer
Grant Amount Received
*
Your answer
Please list the amounts and purpose for which the grant funds were utilized.
*
Your answer
Please provide a short narrative of how these funds assisted your business.
*
Your answer
I certify that the funds received for my business were utilized according to the requirements as established in the business application I submitted.
*
Yes. I certify by checking this box that the funds were utilized according to the requirements as established in the business application I submitted.
No. I certify by checking this box that some or all of the funds were not utilized according to the requirements as established in the business aplication I submitted.
Required
If you answered "No" above please provide an explanation here.
Your answer
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