Premium Member Micro Grant Application
Welcome to the Minnesota Black Chamber of Commerce (MBCC) Premium Member Micro-Grant Application. Please complete the form below to be considered for a micro-grant of $500 to $5,000. This grant is designed to support business growth, operational costs, training, or other development initiatives.
Applicant Information
Business Name
*
Owner's Name
*
First Name
Last Name
Email
*
example@example.com
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
Website (if applicable)
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Business Information
Type of Business
*
Industry
*
Number of Employees (including yourself)
*
Year Business Was Established
*
Annual Revenue
*
Are you a minority owned business?
*
Yes
No
Are you a member of the MN Black Chamber
*
Premium Member
Basic Member
Not a Member
Length of MBCC Membership
*
Less than 6 months
6-12 months
1-2 years
More than 2 years
If unsure of length of membership, please provide the approximate month and year you joined:
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Brief description of your business. (250 word max)
*
0/250
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Grant Request Details
Amount Requested (Between $500 - $5,000)
*
Purpose of the Funds: (Select all that apply)
*
Business Development
Operational Costs
Training and Development
Marketing & Promotion
Other (Please Specify)
Explain How You Will Use the Funds. (250 words max)
*
0/250
How Will This Grant Impact Your Business? (250 words max)
*
0/250
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Supporting Documents
Please upload the following documents:
Business Plan or Summary
*
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Budget Proposal
*
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Most Recent Business Tax Return or Financial Statement
*
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Business License or Registration Certificate
*
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Applicant Declaration
By submitting this application, I affirm that the information provided is true and accurate to the best of my knowledge. I understand that submitting false information may result in the rejection of my application and potential legal consequences. If it is found that any of the submitted information is untrue, I will be responsible for returning the grant amount in full. I understand that grant checks will only be made payable to business banking accounts. I agree that I will provide a brief grant report in six months to one year to demonstrate the growth of my business and that the grant money was used for expenses related to the purposes identified in this grant application. I will keep receipts as I would for normal business expenses in case reports require further review.
Signature
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