Marin $2500 Microbusiness Grant Application

Section 3: Required Documentation to be Uploaded
In order to demonstrate eligibility as a qualified microbusiness owner, please upload ONLY ONE of the following documents:
- 2019 Tax Return (Schedule C, 990, etc.)
- Local business permit or license
- Business bank statement
- Profit and Loss Statements
- Trade Account
- 3rd Party Certification Form
IMPORTANT: If you filed taxes in 2019, please submit your Schedule C as your primary documentation. Your application will not be considered complete if you do not upload a correct document. If you need assistance, please contact Marin SBDC: www.marinsbdc.org/microbizgrantsignup or 415-482-1819 or team@marinsbdc.org *

Cancel of
Did you submit a tax return as your uploaded document? *

Yes No
If you did not submit a tax return, please explain why. *
Please upload a photo/screenshot or scanned copy of a government-issued photo identification to verify your identity. This can be US or foreign ID. *

Cancel of
Please upload a W-9 IRS Form *

You can download this form by going to the 'How to Apply' section on this site: www.marinsbdc.org/microbizgrants
Cancel of
Please enter the address that you wrote in your uploaded W-9 Form. *

Street Address

Street Address Line 2

City State

Postal / Zip Code
Did you enter a social security number, EIN number or ITIN number into your uploaded W-9 Form? *

Social Security number or ITIN number EIN number
Please write the social security number or ITIN number you wrote in your uploaded W-9 Form: *
Please write the EIN number you wrote in your uploaded W-9 Form: *
If you are awarded this grant money, would you prefer to pick up the check or have it mailed to the address listed in your W-9 Form? *

Pick up check at Dominican University 79 Acacia Ave, San Rafael Mailed to address listed in W-9 Form

Section 4: Verifications
By checking this box, I verify that I am the owner or authorized representative of this business and will not apply for or accept more than one award for this grant program. This is the ONLY application I am submitting for this grant program, even if I own multiple businesses. *

I verify that this statement is true.
By checking this box, I verify that my business gross revenue for 2019 was under $50,000. (This is your total revenue before expenses. This is not your income or net profit.) *

I verify that this statement is true.
By checking this box, I verify that my income from other sources did not exceed what I made from this business in 2019 taxable year. I confirm that this business was my primary source of income. *

I verify that this statement is true.
By checking this box, I verify that my business was significantly impacted by the COVID-19 pandemic. I will explain the impact below and/or will show at least a 10% reduction in gross revenue from the 2019 to 2020 taxable years. *

I verify that this statement is true.
Please briefly explain how your business was impacted by COVID-19 and/or show at least 10% decrease in gross revenue from 2019 to 2020. *
By checking this box, I verify that my business has not had more than 5 employees (either part time or full time) at any time in 2019, 2020, 2021, or 2022. *

I verify that this statement is true.
By checking this box, I verify that I am currently operating, and intend to continue business operations after the COVID-19 pandemic. *

I verify that this statement is true.
By checking this box, I verify that my business has not received a CA Grant through the State of California Small Business COVID Relief Grant administered by Lendistry. *

I verify that this statement is true.
By checking this box, I verify that if my business is awarded a grant, I commit my intent is to use the grant funding only for the purpose of business continuation for these items:
- The purchase of new certified equipment
- Investment in working capital
- Application for, or renewal of, a local permit
- Payment of business debt accrued due to the COVID-19 pandemic
- Costs resulting from the COVID-19 pandemic and related health and safety restrictions, or business interruptions or closures incurred as a result of the COVID-19 pandemic, as defined in subdivision (l) of Section 12100.83
Verification: I will use funds for the purposes listed above. *

I verify that this statement is true.

Section 5: Declarations
By checking this box, I understand that if the number of eligible applicants exceed the amount of funding available, the grants will be awarded by a lottery process. *

I understand.
By signing this form, I certify under penalty of criminal prosecution that all information on this form and any additional supporting information submitted with this form is true and complete to the best of my knowledge. Knowingly making a false statement on this form is a violation of Federal law and could result in criminal prosecution, significant civil penalties, and a denial of your grant award.
Signature *

Clear
Date Signed *

Month Day Year
Date
DO NOT SUBMIT YOUR APPLICATION UNTIL YOU ARE CERTAIN THAT IT IS ACCURATE AND COMPLETE. Once you submit your application, it is final. You will not be able to change, correct, or update it.

Thank you for your responses. You do not meet the qualifications for this grant. If you need any assistance or feel this is an error, please contact Marin SBDC at 415-482-1819 or team@marinsbdc.org
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Marin $2500 Microbusiness Grant Application

Section 1: Qualifications

Section 2: Additional Business & Demographic Info

Section 3: Required Documentation to be Uploaded

Section 4: Verifications

Section 5: Declarations

Thank you for your responses. You do not meet the qualifications for this grant. If you need any assistance or feel this is an error, please contact Marin SBDC at 415-482-1819 or team@marinsbdc.org