JCEDC Small Business Development Grant (JC-SBDG) Application

JCEDC Small Business Development Grant (JC-SBDG) MicroGrant Application: Round 3 - New Business Start Up Support

You will need to complete this online application in one sitting as you cannot save it and login later. Please answer all questions that apply (red asterisk indicates required). Only complete applications will be considered.
Applicant/ Point of Contact Information
Applicant/ Point of Contact Name*

First NameLast Name
Applicant/ Point of Contact Email Address*
example@example.com
Applicant/ Point of Contact Phone Number*
Please include area codeFormat: (000) 000-0000.
Business Information
Business Name
Entity may be formally registered or not
Business Entity Type*
Business Legal Type*
Year Business Established
The first year this business filed a tax return
Business Email
example@example.com
Business Phone
Please include area codeFormat: (000) 000-0000.
Business Website
Mailing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Physical Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
YesNo
Business Stage*
Business Industry*
Briefly describe products and/or services the business offers*
Excluding owner(s), partners, and contractors, how many FTP employees does business have today?*
FTP: Full Time Permanent (30 or more hours/week scheduled or worked on average year-round)
Excluding owner(s), partners, and contractors, how many PTP employees does business have today?*
PTP: Part Time Permanent (less than 30 hours/week scheduled or worked on average year-round)
Excluding owner(s), partners, and contractors, how many FTT employees does business have today?*
FTT: Full Time Temporary (30 or more hours/week scheduled or worked on average)
Excluding owner(s), partners, and contractors, how many PTT employees does business have today?*
PTT: Part Time Temporary (less than 30 hours/week scheduled or worked on average)
Business Ownership

If multiple owners, the sum of all owners' percentages must total 100%
Business Owner #1*
Business Owner #2
Business Owner #3
Business Owner #4
Use this space to add additional ownership information, if needed
Your Project Information
Briefly describe how the business will use these grant funds (if awarded)*
Describe how this project will improve the business (if awarded)*
Describe how this project will positively impact the Local and/or Juneau County economy (if awarded)*
Maximum Grant Amount is $5,000

Up to $4,500 for start up costs and up to $500 for continuing education.
Grant Amount Requesting for start up costs.*
Max., $4,500
Grant Amount Requesting for continuing education.*
Max., $500
Supplier/ Vendor Information for Your Anticipated Purchase(s)

For each product or service you intend to purchase with these grant funds (if awarded) please list the item, cost, and supplier information. The sum of all costs listed below should match the total grant amount you are requesting. Here is a link to Juneau County local suppliers and providers. http://www.juneaucounty.com/juneau-county-providers-of-goods--services.html
Supplier #1*
Supplier #2
Supplier #3
Supplier #4
If more than four suppliers use this space to add additional supplier information.
Full Project Data

This requested grant amount may be only part of a larger project cost, or it may be the entire project cost. Please share details.
Total Project Cost*
Remaining Project Cost after requested grant amount is awarded.*
If project cost is the same as requested grant amount, enter zero
If Total Project Cost is greater than this requested grant amount, please list all other funding sources and amounts that will meet the need.*
If project cost is not greater than requested grant amount, enter zero.
Will this project receive any donated products or services (In Kind)? If so, please describe.*
Other Information
Has this business received any grant funding in the past 5 years (federal, state, local, or other)? If so please describe what, when, and how much.*
Answering Yes to this question does not disqualify you from being considered.
Has this business or any of its owners declared bankruptcy? If so, please briefly describe who, what and when.*
Answering Yes to this question does not disqualify you from being considered. All application information will be kept CONFIDENTIAL and only non-personally-identifying aggregate summaries will be reported back to the grant underwriters.
Please describe how involved the owners are in the Local community and/or Juneau County. Include examples or details such as what, how often, dollars donated, hours volunteered, etc.*
Read the Certification Statement Here and Sign If Agree*

Powered by Jotform SignClear
I hereby certify that all the above information in this grant application is true and correct to the best of my knowledge. I understand that any instance of misrepresentation may result in my disqualification from receiving this or future grant funds and/or may necessitate my REPAYMENT of any grant funds received. Furthermore I understand that (a) submitting this application is not a guarantee of award, (b) the decision of the JC-SBDG Committee is final, and (c) the JC-SBDG Committee will not only consider all relevant information from this application but will also strive to allocate awards throughout all communities in Juneau County and to as many industries as possible. In addition I consent to the JC-SBDG Committee's (a) sharing of my voluntarily disclosed data in aggregate, non-personally-identifying ways, to this grant program's underwriter, and (b) utilization of any award photographs or statements for media or promotional purposes. Personal and specific information for all businesses and owners shared here will be kept STRICTLY CONFIDENTIAL. Email addresses will be maintained by JCEDC but their owners will have the right to unsubscribe at any time.
Should be Empty:

JCEDC Small Business Development Grant (JC-SBDG) MicroGrant Application: Round 3 - New Business Start Up Support

Applicant/ Point of Contact Information

Business Information

Business Ownership

Your Project Information

Maximum Grant Amount is $5,000

Supplier/ Vendor Information for Your Anticipated Purchase(s)

Full Project Data

Other Information