Grant Application
$1,000 awarded quarterly
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
TikTok
Instagram
What product or service does your business provide?
Why did you start your business? What motivates you as a business owner?
How are you currently making an impact through your business or brand?
If selected, how would you use the $1,000 grant to grow your business?
Anything else you’d like us to know? Optional – share your story, challenges, or goals
My Products
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Application Fee
To support admin cost, and discourage spam
$15.00
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
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