Interest Form: Mecklenburg County Covid-19 Small Business Recovery Assistance

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The Mecklenburg County Small Business Recovery Assistance Fund will help businesses throughout the County meet their long-term business goals by adjusting to COVID-19 demands. Establishing safe and clean re-opening procedures, in accordance with the Governor’s guidance, is necessary for the safety of customers and employees. It will allow businesses to regain and sustain operations, ideally helping them retain existing staff, fill vacant positions, create new jobs, and become more efficient and resilient. The maximum grant award amount is $10,000.00 per business. Please review the Fact Sheet at www.MecklenburgVa.com for eligibility questions.

This form is not an application. It is an indication to us that you are interested in applying once funds become available. It does not commit you to apply, but it will allow us to get information to you faster and more directly and your answers will help us substantiate our need to apply for future funding opportunities.

Once funding is available, a separate application will be released. Applications will then be reviewed and eligible applicants will be awarded on a first-come, first-served basis until all funds are depleted.

Email *

Business Name *

Business Owner's Name *

Business Phone Number *

Ex (434) 555-1212

Street Address of Business *

Ex. 123 Main Street

If you receive your mail at a PO Box, please provide us with the PO Box #

City *

State *

Zip Code *

Enter your 5-Digit Zip code

Briefly describe the nature/primary function of your business. *

During the Stay-At-Home Order did your business operate at: *

Full Capacity

Below 50% Reduced Capacity

Above 50% Reduced Capacity

Suspended Operations Entirely

What kind of assistance would you be interested in applying for: *

You may select more than one

Space and technology upgrades to reopen and conduct business safely under COVID-19

Sanitation supplies to meet CDC guidelines for reopening safely

Job training/technical assistance to protect my employees or customers from COVID-19, conduct business online, and/or plan long-term sustainability .

Rent/mortgage assistance

Utility assistance

Required

Has your business received any assistance from CARES Act funding (i.e PPP or EIDA)? *

Yes

Is your business a SWAM (Small Woman Owned and Minority ) eligible business? *

Yes

If business disruption continues at the current rate, how soon will your business be at risk of closing permanently? *

Less than 1 month

1-3 months

3-6 months

Not a Concern

Do you wish to receive future email notifications from Mecklenburg County &/or the Southside Planning District Commission (SPDC)? *

Yes

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