Santander Business Growth Scholarship Application

The purpose of this scholarship, funded by a grant from the Santander Consumer USA Foundation, Inc., is to support the local entrepreneur ecosystem specifically as it relates to women, Veteran, and minority-owned businesses headquartered in Pasco County, Florida through a scholarship opportunity of up to $3,600 per recipient. The scholarship is exclusively applicable to the CO.STARTERS Program, the Entrepreneur Roundtable, and the Incubator Program. Each applicant Is only eligible to receive one Santander Business Growth Scholarship.

Scholarships are awarded based solely on
eligibility and availability of funds.

Receiving a scholarship does not imply endorsement of views, opinions, or guarantee success, of the recipient by either The Santander Consumer USA Foundation, Inc. or the Pasco Economic Development Council, Inc.
Applicant Name*

First NameLast NameTitle
Phone Number*

Area CodePhone Number
Mobile Phone Number*

Area CodePhone Number
E-mail Address*
example@example.com
Website Address
www.example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Name (if applicable)
Company Structure*

Individual/Sole ProprietorLimited Liability Company (LLC)C-CorporationS-CorporationPartnershipNon-Profit CorporationStatus Pending
Company Type (Ex: Bakery):*
Business Address (Must be Pasco County Headquartered Business)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
For which Program or Programs are you seeking financial assistance?
CO.STARTERS

CO.STARTERS ($345/9-Week Session)
Session Location / Date
Entrepreneur Roundtable

Entrepreneur Roundtable ($150/Year)
Roundtable Location
Date

MonthDayYear
Date
Incubator Program

Incubator Program (Up to $600/month for up to 6 months)
Entrepreneur Center Location
Type of Membership

On-Site (Dedicated Desk or Office)Offsite (Kitchen or Cowork)
Monthly Cost of Membership

Drop-In/Co-Work $ 10/day or $45/monthOffsite $100/monthDedicated Desk $150-$200/monthOnsite $300-$600/month
Duration of Scholarship
Planned Membership Start Date
TOTAL Scholarship Requested (Maximum $3600)*
Eligibility Determination
Eligibility Determination (Please select one):*

African American/BlackAsian AmericanHispanic/Latino/LatinXNative AmericanWhite (Non-Hispanic)VeteranOther
Gender (Please select one):*

FemaleMaleOther
What will your company do (Description of Products/Services)?*
What is holding you back from getting your business started or growing?*
How will your business diversify the economic base of Pasco County? Are there any social impacts your company will have?*
How will this scholarship assist your business and how do you plan to measure your success?*
Acknowledgement & Signature
Date*

MonthDayYear
Date
Authorized Signature*

Clear
Printed Name*
Please verify that you are human*
Should be Empty: