COVID-19 Small Business Relief Grant Application
The COVID-19 Relief Grant is available to small businesses located downtown De Pere within the Business Improvement District. The program is intended to provide short-term financial assistance to independent locally owned businesses impacted by the unanticipated March 17, 2020 state-mandated shutdown orders in response to the coronavirus pandemic.  

Online applications will be accepted until Thursday, April 30, 2020 at 12 midnight.

The maximum grant request is $2,500.

Sign in to Google to save your progress. Learn more
Business Owner Name
Business Name
Business Address
Phone Number
Email Address
Criteria to apply
Date of business start-up
Brief description of the hardship your business has endured due to COVID-19 (ie loss in sales, canceled orders, employee layoffs, etc).
Number of employees (FT and PT) prior to the coronavirus outbreak.
Number of employees (FT and PT) laid off or furloughed since March 17, 2020.
Business revenue for March and April, 2020 compared to March and April, 2019 is:
Provide a description of how you have temporarily changed your business model due to COVID-19 (ie online sales, delivery services, curbside pick up, etc).
Describe your tentative plans for reopening when the Safer at Home order ceases (ie grand reopening sale, special event, advertising and marketing, etc).
Other sources of financial assistance you have applied for and/or received.
Please describe the status of the longer term funding you are seeking (ie applied for EIDL, received PPP, etc).
How do you plan to use the grant? Check all that apply.
Grant dollar amount requested:
Note: The amount granted may be less than what is requested depending on the availability of funds and the amount of funding requests. Any application in which the amount requested is reduced may be reviewed for additional funding should it become available.

Grants are awarded based on need. We may request additional information such as copies of statements/invoices for above referenced eligible expenses that apply to the grant request.

Please share any additional information you would like the grant committee to consider as they review your grant application.
Certification by Applicant
I certify that I have suffered a loss due to the COVID-19 pandemic as stated in this application and that all information contained in this application is true and complete.

I understand that a fraudulent representation or omission of any information requested is grounds for immediate refusal for a grant from this fund. I certify that I will use all grant dollars I may receive from the COVID-19 Relief Fund as stated in this application.

I understand a grant from this fund is neither a right nor an entitlement, and that the COVID-19 Relief Fund Application Review Committee shall have sole discretion in determining whether I qualify for assistance.

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms