About: This form is designed to help applicants calculate the Restore RI Grant amount they may be eligible for.
Before beginning, please review program guidelines and check eligibility on
• Applicants with employees or qualifying independent contractors are required to upload this completed form as
part of the application process.
You'll see a "Download PDF" button at the bottom of the form - clicking this will download your
information and allow you to save it to your device.
• Applicants without employees or independent contractors are NOT required to upload this completed
form during the application process, but may find it helpful for documenting eligible expenses (you may be
asked to provide either a list of eligible expenses and/or documentation of eligible expenses during the application process).
Using this form: Please fill in the boxes in white. Other items are not editable to prevent errors.
Please list your eligible expenses since March 1, 2020 or that you will have through December 1, 2020 in the table below.
Expenses you list cannot be covered by any other state or federal funding source (e.g. PPP, EIDL loans, DHS' Child Care Provider Relief Fund,
RI Foundation nonprofit grants, RIDOH's HEZ grants). Future expenses are allowed.
Please retain documentation (e.g. receipts, invoices, bank statements, etc.) of the expenses you list as you may be
asked to provide documentation of expenses during the application process. It is recommended to list higher value expenses (e.g. rent)
to reduce the documentation you need to retain.
Note: you will be required to attest that data provided is accurate and true when you submit.
Making intentional misrepresentations of fact will be subject to federal criminal prosecution.
Select category from dropdown menu for each entry.
Example: Rent or mortgage interest payment.
Describe the fixed cost or COVID-related expense.
Examples: (1) May rent, (2) April internet bill, and (3) tent and planters from hardware store for new outdoor seating area.
Date of invoice or payment (shown on retained documents).
Amounts must match those shown on retained documents(e.g. receipt, invoice, monthly statemtent, lease statement, etc.)