Take It Outside- Small Business Application

Take It Outside- Small Business Application

To be eligible to receive support from an Intermediary under the Take it Outside (TIO) program, a small business must meet certain eligibility criteria. This application allows the Take It Outside team to vet applicants as well as track the supports given to businesses.
Applicant Email *
Legal Business Name (Please provide the exact legal business name (e.g., Main Street Business, LLC), as listed on your Secretary of State filing, or tax filing. If your business is not incorporated (e.g., you file a Schedule C with your personal tax return), please list your legal first and last name here.) *
If applicable, business DBA ("Doing Business As")
Name of Business Owner or Authorized Representative (First and Last) *

First Name Last Name
Physical Business Address *
Physical Business City *
Physical Business Zip Code *
Business Mailing Address *
Business Mailing City *
Business Mailing Zip Code *
Business Phone Number *

Area Code Phone Number
Business Taxpayer Identification Number *
Is your business in or considering federal bankruptcy or state receivership? "Yes” means that your business is in or considering federal bankruptcy or state receivership. “No” means that your business is not in or considering federal bankruptcy or state receivership. *

Yes No
Is the business permanently closed? If you are taking actions necessary for running your business and generating business income, your business would not be considered permanently closed. Seasonal businesses should answer “No” even if they are not yet open for the 2022 season. *

Yes No
Is your business at least 51% owned by women and/or minorities ( A small business concern which is at least fifty-one percent (51%) owned and controlled by one or more socially and economically disadvantaged individuals or in the case of a publicly owned business, at least fifty-one (51%) of the stock of which is owned by one or more socially and economically disadvantaged individuals; and whose management and daily business operations are controlled by one or more such individuals. "Socially and economically disadvantaged individuals" are individuals who are citizens or lawful permanent residents of the United States the following groups are presumed to be both socially and economically disadvantaged: Members of a definable minority group means a person who is a citizen or lawful permanent resident of the United States and who is listed below)? *

Yes No
If you answered yes, please check the following box(es) to indicate ownership descriptions: *

Women (Any female qualifies as a class of minority.) Black (All persons having origins in any of the Black racial groups of Africa.) Hispanic (All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.) Portuguese (All persons of Portuguese, Brazilian or other Portuguese culture or origin regardless of race.) Asian (All persons having origins in any of the original peoples of the Far East, Southeast, Southeast Asia, the Indian Subcontinent, or the Pacific Islands.) American Indian/Native American (All persons having origins in any of the original peoples of North America.) Eskimo/Aleut Economically and Socially Disadvantaged (Members of other groups or other individuals, found to be economically and socially disadvantaged by the small Business Administration under Section 8 (a) of the Small business Act, as amended (15 U.S.C. Chapter 637 (a)).) Not Disclosing
Which intermediary are you partnering with under this Take It Outside grant program? *

Center for Southeast Asians Central Rhode Island Chamber of Commerce City of Cranston City of East Providence City of Pawtucket East Greenwich Chamber of Commerce Federal Hill Commerce Association NeighborWorks Blackstone Valley North Kingstown Chamber of Commerce Northern RI Chamber of Commerce Ocean Community Chamber of Commerce Providence Downtown Improvement District Providence Revolving Fund RI Brewers Guild Rhode Island Hospitality Association The Pawtucket Foundation Town of Cumberland Town of North Providence Town of Smithfield Town of Warren Woonasquatucket River Watershed Council I do not have a designated intermediary and would like to be connected to one.
Have you received funding from an additional intermediary under this Take It Outside program? *

Yes No
If yes, please specify which
Please explain how your business has been negatively impacted by COVID-19? (Note: This is a requirement for receiving support through the Take It Outside program.) *

Being forced to close or curtail business operations due to the pandemic or a government order pertaining to the pandemic Experiencing a supply chain delay or disruption that negatively impacted operations Experiencing increased cost as a result of the pandemic Being forced to lay off workers as a result of the pandemic Other
If you chose "Other," please specify:
Did your business earn less than $1 million in gross revenue in either 2020 or 2021? Please choose the revenue range that most closely reflects your gross revenue (Note: This is a requirement for receiving support through the Take It Outside program.) *

$0-$50,000 $50,001-$100,000 $100,001-$250,000 $250,001-$500,000 $500,000-$999,999 $1,000,000 or greater
Do you attest to your establishment being not disbarred from SAM.gov? (Note: This is a requirement for receiving in-kind or programmatic support through the Take It Outside program.) *

Yes No
If you are seeking reimbursement from an intermediary, do you attest that your establishment is registered in SAM.gov or if you are a sole proprietor, you have a UEI? *

Yes No Not seeking reimbursement
Will this support assist your business with expanding your outdoor capacity? *

Yes No
Will this support assist your business with expanding business operations? *

Yes No
Signature *

Clear
Date *

Month Day Year
Date
Please verify that you are human *
Should be Empty:

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