Gloucester COVID-19 Business Assistance Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dear Gloucester Business Owner/Operator,

On behalf of Mayor Sefatia Romeo Theken we hope you are safe and healthy during this difficult time. If you are a business owner or non-profit executive director seeking assistance due to the impact of the coronavirus, please fill out the form below. We are working with state and federal agencies to connect Gloucester businesses with assistance programs available. We will follow up with additional information and questions from the Commonwealth or the Federal Government as they become available.

Thank you.

Sincerely,

Sal Di Stefano
City of Gloucester
Economic Development Director & Business Liaison for COVID-19 Emergency Response
978-325-5236
sdistefano@gloucester-ma.gov

Email *

Business Name *

Address of location in Gloucester *

Business Contact Person and position *

Mobile Phone number *

Number of Total employees *

Industry *

Please select business assistance requested *

Business Loans (SBA EIDL program, etc.)

Workforce assistance (Workshare, Unemployment assistance from the Commonwealth)

City related issue (health department questions, inspections)

Other (please state need in next setion)

Required

Other: Please list need and be as specific as possible.

Please indicate your organization type *

Private entity

Non-profit

Have you had to lay off employees? *

Yes

If yes, please indicate how many were laid off.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of City of Gloucester. Report Abuse

Forms