Main Street Revitalization Program Application
Business Information
A series of basic questions about the business
Business Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Owner's Email
*
example@example.com
Business Website
Optional
Business Owner's Name
*
First Name
Last Name
Legal Name of Business
*
As registered with the state
DOB Name
"Doing Business As" Name (optional)
Number of Years in Operation
*
0 - 4 years
5 - 9 years
10 - 15 years
Longer than 15 years
Date of Business Registered with the State
*
-
Month
-
Day
Year
Date
Employer Identification Number
*
Format: xx-xxxxxxx
Legal Structure of Business
*
Sole proprietorship
Limited Liability Company
S Corporation
C Corporation
Nonprofit 501c3
Number of Employees
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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State of the Business
A series of questions to better understand the mission and the impact of economic instability on the business
Describe the Purpose of the Business or the Mission Statement
*
0/200
Was the Business Impacted by COVID-19?
*
Yes
No
Describe the Impact of Covid-19 on the Business
Was the Business Impacted by the Civil Uprising/ Unrest (e.g. George Floyd Events)?
*
Yes
No
Describe the Impact of the Civil Uprising/ Unrest on your Business
Describe the Business Target Population and Plans for Community/Stakeholder Engagement Efforts
*
0/200
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Project Information
A series of questions to understand the project and it's scope
Project Location
*
e.g., Business Office in XYZ city, Parking lot in front of Business Office, etc,.
Summary of Proposed Project/ Work
*
0/300
Summary of Project Completion Plan
*
0/300
Project Budget
*
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Fill Out and Upload the Project Budget Document: https://drive.google.com/file/d/1qfR0rp523HcWJEg7tx4sXnO8LcsFvgtf/view
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