Financial and Operational Capacity Building Program
This program, funded through Community Development Block Grants (CDBG), is designed to support small business owners whose household income is at 80% or below the median in the City of Tacoma.
Your Business Information
Applicant Name
*
First Name
Last Name
Title
*
Age (please check one)
Under 20
20 - 29
30 – 39
40 - 54
55 - 70
Over 70
Email
*
example@example.com
Business Name
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the legal structure of your business?
*
Sole Proprietorship
Limited Liability Corporation (LLC)
S Corporation
Partnership
What industry does your business operate in?
*
Please Select
Accommodation and Hospitality
Construction and Home Services
Creative Industries
Education
Financial Services
Food Services and Restaurants
Healthcare
Non-Profit
Personal Services (e.g., hair salons, fitness, etc.)
Professional Services
Retail and e-Commerce
Other
What year was your business established?
*
Business Status
*
Full Time
Part Time
What is your SAM Unique Entity ID?
What is your City of Tacoma Business license number?
Equity and Inclusion Information
Does your business primarily serve or employ individuals from historically marginalized or underserved communities?
*
Yes
No
Race/Ethnicity of primary business owner with majority (more than 50%) ownership
*
White
Black/African American
Asian
American Indian/Alaska Native
Native Hawaiin/Other Pacific Islander
Other/Multi Racial
Hispanic Latino
Gender
of primary business owner/applicant with majority (more than 50%) ownership
*
Female
Male
Non-binary
Rather Not Say
Prefer to self-describe:
Primary language spoken
CDBG INCOME INFORMATION
Revby LL Receives federal Community Development Block Grant (CDBG) pass-through funding from the City of Tacoma. CDBG regulations mandate that funds benefit low-and moderate-income persons. For these reasons, we ask that you complete this Self-Certification of Gross Annual Household Income.
Enter projected 12 month gross annual income from date of application (before taxes), including income from assets, of each household member. If a member has no income, enter “Zero”.
*
Rows
Household Member Name
Type of Income
Total Projected Gross Annual Income & Assets
Head
Earned income
Profit income
Interest Dividend income
Rental income
Capital gains
Royalties
Passive income
1
Earned income
Profit income
Interest Dividend income
Rental income
Capital gains
Royalties
Passive income
2
Earned income
Profit income
Interest Dividend income
Rental income
Capital gains
Royalties
Passive income
3
Earned income
Profit income
Interest Dividend income
Rental income
Capital gains
Royalties
Passive income
4
Earned income
Profit income
Interest Dividend income
Rental income
Capital gains
Royalties
Passive income
5
Earned income
Profit income
Interest Dividend income
Rental income
Capital gains
Royalties
Passive income
Total Household Income
Earned income
Profit income
Interest Dividend income
Rental income
Capital gains
Royalties
Passive income
Do you have other income from Assets such as investment income or appreciation?
*
Yes
No
If you answered yes, please enter projected 12 month gross annual income from Assets
Rows
Household Member Name
Type of Income
Total Projected Gross Annual Income & Assets
Head
1
2
3
4
5
Total Household Income
Please upload your most recent tax returns for your household and any files documenting extra income such as grants, rental property income, or interest bearing accounts.
*
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Business Operation Details
How many employees do you currently have?
*
What was your business's annual revenue for the most recent fiscal year?
*
Less than $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
More than $500,000
How would you rate your current use of technology in your business operations?
*
Very Low
Moderate
High
Business Challenges and Needs
What are the top three financial challenges your business is currently facing?
*
Managing cash flow and expenses
Setting up or improving bookkeeping systems
Understanding business financial statements
Accessing funding or small business loans
Budgeting for growth and sustainability
Managing taxes and financial compliance
Pricing products or services effectively
Reducing business costs and increasing profitability
Which financial area would you like to focus on?
*
Cash flow management and forecasting
Bookkeeping and accounting best practices
Understanding financial statements and reports
Accessing capital and loan readiness
Budgeting and financial planning for growth
Tax preparation and compliance strategies
Cost-cutting and profitability improvement
What are your business growth plans for the next 12-24 months?
*
Expanding Products/Services
Entering New Markets
Hiring More Staff
Investing in Technology
Other
Your Participation Readiness
Have you previously participated in any other technical assistance or business development programs?
*
Yes
No
Are you prepared to participate in at least two one-on-one Zoom meetings with a business consultant to work on your business strategies?
*
Yes
No
Would you rather participate in workshops...
*
In Person
Online
Hybrid
Acknowledgement
I certify under penalties of perjury that the above information is true and complete to the best of my knowledge and belief. I agree to furnish any additional income or other documentation as requested and required by the Service Provider to determine their compliance with federal requirements resulting from the use of federal funds in this project.
Business Owner Signature:
*
Submit
Should be Empty: