Link Match Brick & Mortar Grant Application

Brick & Mortar Link Match Grant Application
This application is for Brick and Mortar locations only - for farmers markets, farm stands, CSAs, etc. please return to www.LinkUpIL.org and apply through the 'Farm Direct' program application.

Link Up Illinois works to increase affordable access to fresh fruits and vegetables for SNAP (Supplemental Nutrition Assistance Program, or Illinois ‘Link’) recipients shopping at participating Illinois locations. Link Up Illinois provides grant funding, training, and technical assistance to participating venues across the state to implement Link Match programs.

With generous support from the USDA's GusNIP grant award program, the State of Illinois, and corporate and private donors, Link Up Illinois matches the value of Link purchases, giving Link customers greater buying power towards the purchase of fresh fruits and vegetables.

This application should take you no more than 30 minutes to complete. You may save this application and continue later. Upon completion, you should receive a confirmation email about your application. Please notify us if you believe you submitted an application and did not receive confirmation.

Applications are reviewed and approved throughout the year - there is no application deadline.

Grant Award Amounts: Grant awards will vary based on store/market needs and capacity to operate the program. Link Up Illinois reserves the right to fund less than the requested amount.

Program Requirements
- Only stores/markets that are authorized by the USDA as SNAP retailers can apply for a Link Match grant.
- Have a designated store/market manager (or equivalent) responsible for the project and sufficient organizational capacity to handle the associated accounting and reporting.
- Participate in program onboarding training and evaluation.
- Maintain records, input data in a designated data portal, provide data as required by Link Up Illinois funders, and submit an annual End-of-Year report in a format requested by Link Up Illinois.
- Promote your market's Link Match program at your store/market and throughout your community, focusing especially on the low-income population.
- Use approved Link Up Illinois Link Match program language for press releases and marketing materials concerning Link Up Illinois-funded programs.
- List Link Up Illinois as a program sponsor in print and digital marketing, including the use of the Link Up Illinois logo.
- Use Link Up Illinois Universal Link Match currency for the distribution and redemption of the Link Match incentive.
- Link Match may only be used to purchase fresh fruits and vegetables sold at participating locations.
As a Link Up Illinois Link Match grant recipient, you can expect us to:
- Provide training and technical support for program implementation and strategies for community outreach and education.
- Provide training on how to implement the Link Match program and distribute Link Match currency.
- Provide training for data collection and submission using our designated data portal.
- Provide digital marketing materials for your market to use for program promotion and customer education.
Before beginning this application, it is suggested that you gather the following information (as applicable):
- Contact information for all responsible parties (Market/Store Manager, Executive Director, etc.).
- Accessibility information for your market/store.
- SNAP transaction Federal Nutrition Service (FNS) certificate number
- Employer Identification Number (EIN)
- Dates, times, location(s) of your store(s)
- Vendor information
- Current incentive program information
- Information about past grants and other funding sources.
Funding for this project was provided in part by the United States Department of Agriculture (USDA). As such, if you are approved as a Link Match grantee, then we will be issuing a USDA Memorandum of Understanding (MOU) that will be signed by the contract signee. If you're a returning partner, we will need to renew your MOU.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

(2) fax: (202) 690-7442; or

(3) email: program.intake@usda.gov.

This institution is an equal opportunity provider.
Organization Information
Organization Name *
What is the tax status of the {sponsoringorg}?*

501(c)3 nonprofit organizationState of IL not-for-profitMunicipality: City/Township/Municipal Government or Government Department501(c)6 Business League or Chamber of CommerceLimited Liability Corporation (LLC)CorporationFederally recognized Indian TribePublic UniversityAn independent market not organized as any of the above optionsAn individual who manages the market’s finances as a sole proprietor
Enter the EIN number*
An employer identification number (EIN) is a nine-digit number assigned by the IRS.
Does {sponsoringorg} have an FNS number?*

Yes, and it's activeYes, but it's not yet active (we haven't been notified of approval)No, we haven't applied for an FNS number yet
FNS Number*
What year did you get your FNS number?*
What year did your store start accepting SNAP?*
In addition to Link Match, will your store operate other Link/SNAP matching or discount programs?*

YesNo
Please explain how your additional program operates:*
Mailing Address for {sponsoringorg}*

Street Address

Street Address Line 2

CityState

Zip Code
Contract Signee Information

Please provide contact information for the person with authority to sign contracts (e.g. Executive Director, Store Owner, etc.) on behalf of your organization.
Name*

First NameLast Name
Title*
e.g. Executive Director, Store Owner, etc.
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Is this your primary contact regarding application and program administration during the grant cycle?*

YesNo
Primary Contact Information

Please provide contact information for the best person to contact regarding your application and program during the grant cycle.
Name*

First NameLast Name
Title*
e.g Store Manager, Market Manager, etc.
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
General Information
Name of Store*
What bests describes your store?*

Food Co-opCorner Store/Convenience StoreNeighborhood Grocer/Small Grocery StoreMid-sized Grocery StoreFull-Service SupermarketSpecialty StoreFood Delivery Service
Is {fiscal_MailingAddress} your store's physical address?*

YesNo
Store's Physical Street Address*

Street Address

Street Address Line 2

CityState

Zip Code
Can you receive mail for {storename} at {storephysicalStreetAddress}?*

YesNo
Store Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is your store open 7 days a week?*

YesNo
Are the hours of operation the same each day?*

Each day has same operating hoursMonday through Friday are the same, Saturday and Sunday are differentEach day has different operating hours
What days is your store open?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Everyday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Monday through Friday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Monday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Tuesday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Wednesday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Thursday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Friday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Saturday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Sunday Hours*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
Staff Information
Is {primarycontact_name} also the store manager?*

YesNo
Store Manager Name*

First NameLast Name
Store Manager Email*
example@example.com
Store Manager Phone Number*
Please enter a valid phone number.
How many staff members do you employ?*
Store Services and Details
What is the approximate square footage of your store?*
Is your store ADA accessible?*

YesNo
Do you accept any other Nutrition Assistance Programs? Select all that apply.*

CSFPFDPIROTC Healthy FoodTANFWICNone
CSFP - Commodity Supplemental Food Program

FDPIR - Food Distribution Program on Indian Reservations

OTC Healthy Food - Over the Counter Healthy Food

TANF - Termporary Assistanc efor Needy Families

WIC - Women, Infant, and Children
Does your store offer in-store food or nutrition education ? Select all that apply*

1-on-1 CoachingDiabetes Prevention Program (DPP Classes)E-InterventionsGardening DemonstrationsNutrition Ed MaterialsPower of ProduceRD ConsultationsRecipes or CookbooksSNAP-Ed Programs, EFNEP, or Extension ProgramsSupport GroupsTaste Test/Cooking DemosTeaching KitchensTeam NutritionToursWIC Nutrition EducationNone
Does you store offer any auxiliary services?*

Benefit Application AssistanceDelivery ServicesFitness ProgramHealth ScreeningImmunizationsNutrition or Cooking InfoResource ReferralsShopping AssistanceTransportationVoter RegistrationNone
What advertising/marketing strategies does your store use?*

DirectoriesMobile apps or Search Engine OptimizationMulti-lingual promotionsOn-site signage or In-store announcements (over loudspeaker)Online advertisements (e.g., social media, website or blog, banner ads)Outdoor, Transit, or Billboard advertisementsPrint advertisements (e.g., newspapers, magazines, brochures)Promotions distributed by direct mail (e.g., postcards, coupons, flyers)Promotions distributed by email (e.g., list serves, e-newsletters)Promotions distributed by phone (e.g., robo-calls or texts)Provider referralPublic relations and events (e.g., media coverage, press releases)Radio or TV advertisementsNone
Fresh Produce Procurement and Storage Capacity
In order to support local farmers, Link Up Illinois requests that partners source locally or regionally grown produce when possible. We define local as "produce grown within Illinois or within 250 miles," and regional as "produce grown within 400 miles." Does your store currently sell and track locally or regionally grown produce?*

YesNo
Which suppliers do you currently purchase produce from? Please list.*
How can Link Up Illinois help so that some of your store's produce is sourced locally between May and November?*
Please note that we appreciate your suggestions, and will do our best to assist as much as we can.
Can you commit to having 25% of your produce come from local sources (saying no does not disqualify you from grant eligibility)?*

YesNo
Store Technology and Systems
What is the make/model of your point of sale (POS) terminal?*
Example: PAX a920, Clover Flex. Enter "Don't know" if you are unsure.
Which company provides IT services for your POS system?*
Examples: LOC Software, Retail Data Systems (RDS). Enter "Don't know" if you are unsure.
General Food Sales Data
In the last fiscal year, what were your total food sales?*
Including prepared foods and standard grocery items
In the last fiscal year, what were your total SNAP sales?*
Including fresh, frozen, and dried fruits and vegetables
In the last fiscal year, what were your total fresh produce sales?*
Please report total for ONLY fresh fruit and vegetable sales were $20,000 in 2022
Social Media and Website

Social media pages

	URL/Handle
Website
Instagram
Facebook
Twitter
Other

Website
Instagram
Facebook
Twitter
Other
Program Sustainability
What are your goals and objectives for administering the Link Match program?*
How would you rate the current engagement level of your local community with regards to your store/market?*

High EngagementMedium EngagementLow Engagement

I understand that if approved, program participation requirements include but are not limited to:*

	I Understand
Submitting data in the online reporting tool on a weekly basis.
Attending regular check-ins (phone call or video call).
Attending two mandatory training sessions before I begin distributing Link Match currencies at my store/market.
Sourcing fresh produce from local farms (direct or through a distributor) between May and November.
Signing up for bill.com if I am approved, in order to receive payments.
Partnering with community organizations to educate shoppers and advertise the Link Match program at my store.

Understood?*
What concerns or questions do you have about running the Link Match program at your site? Please write them here and we'll respond as soon as we can!*
Please upload your store logo, using a .png file or .jpg format. This will be added to custom marketing materials and Link Match vouchers for your store.

If you need assistance, please email us directly (linkup@experimentalstation.org).
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Brick & Mortar Link Match Grant Application

Organization Information

Contract Signee Information

Primary Contact Information

General Information

Staff Information

Store Services and Details

Fresh Produce Procurement and Storage Capacity

Store Technology and Systems

General Food Sales Data

Social Media and Website

Program Sustainability