City of Connersville COVID-19                              Phase 3 Business Grant Application
The Grant Application Herein Certifies That:
To The Best of the Applicants Knowledge and belief, the information presented in this grant application is true and correct; and,
a. The applicant understands that the City of Connersville will be required to collect and submit, semi-annually,
        a status of business report to the Indiana Office of Community and Rural Affairs for two years after grants
        funds are received; and,
b. The grant applicant agrees to allow the City of Connersville to include your business name in all award
        announcements to the media.
c. A 1099 G will be issued to each business that receives funding.
d. Non-profits are not eligible for funding.

Applications Should Be Submitted Online Only.
Please fill out all lines with red asterisks.
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Business Name *
Owner's Name/s *
Phone Number *
Street Address *
City, State, Zip *
Email Address *
EIN Number *
Requested Grant Amount *
Indicate the Type of Business *
Please give a description of how your business has been impacted by COVID-19.  Tell us why you need this assistance.   *
Please give a brief description of how you plan to use the funds. *
These funds require verification of job retention and that 51% of all jobs retained meet the low/moderate income threshold. Please provide the following information for all jobs in your business, including the owner. List the Person's Initials, Job Titles, and Wage of all Employees (Example: RG - Sales Rep. - $32,000 yearly) *
What is Your Business Classification? *
How Many Years Have You Been in Business? *
How Many Employees Do You Have Besides Yourself? *
Were You Directed or Mandated to Close or Reduce Hours During the Pandemic? *
Have You Reopened? *
What Effect Has the Pandemic Had On Your Sales? *
Are You Still Employing the Same Number or More Compared to March 1, 2020? *
Did You Lay Off or Furlough Any Employees Since March 1, 2021? *
Have Any of Your Employees Transitioned to Work at Home Permanently? *
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