Instructions: Please enter the information requested in the white boxes below only.
All fields with grey backgrounds are not editable and are designed to indicate whether the applicant
is eligible and calculate the maximum grant. Note that the actual grant amount is subject to
documentation and approval in the application.
Note: You will be required to attest that the data provided is accurate and true.
Making intentional misrepresentations of fact will be subject to federal criminal prosecution.
You will be required in the application to provide supporting documentation to validate the
information you provide here. Please save this file for your future use. You may be
asked to edit or upload this file during step 2 of the application.
Note: Please be sure to complete 1c above before beginning this section.
Instructions: Please list your eligible expenses incurred since March 1, 2020 in the section below. These expenses cannot be the same as those covered by any other state or federal funding source (for example: PPP or EIDL loans). Please list higher value expenses (e.g. rent) in order to reduce the documentation you need to retain. Note that your grant may not exceed the amount of the eligible expenses listed below.
Note: you will be required to attest that the data provided is accurate and true when you submit. Making intentional misrepresentations of fact will be subject to federal criminal prosecution.
Please select an expense category from dropdown menu for each entry.
Example: Rent or mortgage interest payment.
Please describe the expense listed and in a few words how the expense is COVID related.
Example: Tents, planters and landscaping supplies from Hardware Store for new outdoor seating area.
Please indicate the date of the invoice or payment. If applicable, use the date of the documentation submitted.
Indicate the amount spent on this cost item. Amount must match documented receipt, invoice, monthly statement, lease statement, etc.