Grant Application for Technical Assistance

Grant Application for Technical Assistance

2024 - 2025 For businesses with fewer than 20 employees
Please note: All questions on this application are required in order to meet our funder’s compliance guidelines. If you need assistance, clarification, or have questions about any section, please don’t hesitate to reach out. Contact our Program Coordinator: Lindsay Aucoin, at 413-497-4409 or Lindsaya@qvcdc.org — We're here to help!
Applicant's Name*
Date*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Residential Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Name*
Business Mailing Address. If your business is home based add your residential address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What does/will the business do?*
Please let us know about your business

Please note: All questions on this application are required in order to meet our funder’s compliance guidelines. If you need assistance, clarification, or have questions about any section, please don’t hesitate to reach out. Contact our Program Coordinator: Lindsay Aucoin, at 413-497-4409 or Lindsaya@qvcdc.org — We're here to help!
Business Income Information:
How long have you been in business?*
Business Status*

DBALLCOther
If other please specify*
Please type NA if you have not checked "other"
How many owners does the business have?*
List owners name and what percentage of the business does each one own?*
Number of people employed?*
Count owner as employee
How many full-time employees (including Owner(s)?*
Count owner as full time
How many part-time employees (including Owner(s)?*
If there are no part-time employees enter NA
What are the average hours of the part-time employees?*
If there are no part-time employees enter 0
Upload current DBA Certificate / Annual Report*

Upload any appropriate documents heres
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Current Federal Taxes For All Family Members Must Be Submitted To Confirm Income
Owner/Applicant annual family income*
Number of persons in your family*
Please upload your tax return*

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Contract Agreement
Please Initial on each line below: I understand that all information provided by the QVCDC or an independent consultant may be accepted or rejected at my discretion at any time. I agree to hold the Quaboag Valley CDC (QVCDC), any third-party representative and/or independent consultant harmless against any liability, loss or damage cause by or arising from the use of any and all information or materials furnished by the QVCDC, representative and/or independent consultant in connection with my participation therein.*
I certify that all of the information provided in this applicationis true and correct to best of my knowledge. I further understand theinformation that I provide may be verified by a third party and it may be usedto determine eligibility for program services.*
I certify that I am over 18 years of age, that I agree to the terms and conditions of this application and that I am responsible for ensuring that the work for which I may be deemed eligible is completed in a timely manner.*
By submitting this application, I agree to provide QVCDC and its funders with follow-up reports and/or surveys about my business.*
I give my permission to the Quaboag Valley Community Development Corporation (QVCDC) to use my name, the name of my business/organization, and/or my picture or a picture of my business or organization for the purpose of promoting their programs, reporting on their programs, or securing additional funds for their programs.*
QVCDC does not certify consultants however we do require that consultants show proof of competency when applicable such as a license or certification.*
Print Name*

First NameLast Name
Date*

MonthDayYear
Date
Signature*

Clear

Release Form
The undersigned hereby consents to the use of my name, the name of my business/organization, the participation in interviews, the use of quotes and the taking of photographs or videos or any other media (collectively, the "Materials") by the Quaboag Valley Community Development Corporation & Quaboag Valley Business Assistance Corporation, their advertising agency, and all of their agents, designees and assignees (collectively, the "Designees") for the purpose of promoting their programs, reporting on their programs or securing additional funds for their programs.

I also grant to the Quaboag Valley Community Development Corporation & Quaboag Valley Business Assistance Corporation and the other Designees the right to edit, use and reuse said Materials for any purpose, including the use in print, on the internet and all other forms of media and social media including Facebook and all other commercial advertising. I also hereby release the Quaboag Valley Community Development Corporation &Quaboag Valley Business Assistance Corporation and its agents and employees and all other Designees from all claims, demands and liabilities whatsoever in connection with the above.
Print Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please verify that you are human*
Should be Empty:

Grant Application for Technical Assistance

Business Income Information:

Technical Assistance Information

Demographic Information

Contract Agreement

Release Form