PURPOSE REDEFINED BUSINESS SOLUTIONS
BUSINESS GRANT INTEREST & PRE-SCREENING INTAKE
Thank you for your interest in Business Grant Assistance through Purpose Redefined Business Solutions. This questionnaire helps us understand your business, funding needs, and current level of grant readiness. Completing this form does not guarantee grant eligibility, application acceptance, or funding. Please provide complete and accurate information so we can determine the appropriate next step for your business.
SECTION 1 - CONTACT INFORMATION
1. Full Name *
*
First Name
Last Name
2. Email Address *
*
example@example.com
3. Phone Number *
*
Format: (000) 000-0000.
4. Preferred Method of Contact *
*
Email
Phone
Text
SECTION 2 - TELL US ABOUT YOUR BUSINESS
5. Tell us about your business and what you are seeking grant funding for. *
*
6. What is the current status of your business? *
*
Business idea / not established yet
Startup / establishing business
Established and operating
Established but temporarily inactive
Nonprofit organization
Other
7. Business Name
8. What industry is your business in?
9. Business Location (City / State) *
*
10. How long have you been in business?
Not started yet
Less than 6 months
6-12 months
1-2 years
3-5 years
5+ years
SECTION 3 - BUSINESS FOUNDATION
11. Is your business legally registered?
Yes
No
In Process
Back
Next
12. What is your business structure?
Sole Proprietorship
LLC
Corporation
Partnership
Nonprofit
Not Sure
Not Yet Established
13. Does the business have an EIN?
Yes
No
In Process
14. Do you have a dedicated business bank account?
Yes
No
15. Do you have required licenses or permits for your industry?
Yes
No
Not Required
Not Sure
16. Does your business currently generate revenue?
Yes
No
If yes, approximate revenue generated during the last 12 months:
$1-$5,000
$5,001-$25,000
$25,001-$50,000
$50,001-$100,000
$100,001-$250,000
$250,001+
SECTION 4 - FUNDING NEED
17. Approximately how much grant funding are you seeking? *
*
Under $5,000
$5,000-$10,000
$10,001-$25,000
$25,001-$50,000
$50,001-$100,000
$100,000+
I'm not sure
18. What specifically would you use the grant funding for? Check all that apply.
Equipment
Inventory
Commercial space
Renovations
Marketing/advertising
Technology/software
Hiring/payroll
Training/certifications
Vehicles/transportation
Product development
Expansion
Working capital
Community program/project
Research/development
Other
19. Please explain exactly what you hope the funding will help your business accomplish. *
*
SECTION 5 - GRANT READINESS
20. Which documents do you currently have available? Check all that apply.
EIN confirmation
Articles of Organization/Incorporation
Business license
Business bank statements
Business tax returns
Profit & Loss statement
Balance sheet
Business plan
Business budget
Owner resume/professional bio
W-9
Capability statement
Website
None of the above
Other
21. Do you currently have a written business plan?
Yes
No
Currently Working on It
22. Do you have organized financial records/bookkeeping?
Yes
No
Somewhat
23. Have you applied for business grants before?
Yes
No
Back
Next
If yes, list the grant(s), approximate application date(s), and outcome(s):
SECTION 6 - FUNDING HISTORY
24. Has your business previously received a grant?
Yes
No
If yes, provide the grant name, approximate amount, year received, and how funds were used:
25. Are you currently applying for any other grants or business funding?
Yes
No
If yes, briefly explain:
26. Do you already have a specific grant opportunity you want assistance with?
Yes
No
If yes, provide the grant name, application deadline, and official application link:
SECTION 7 - TIMELINE & ASSISTANCE
27. When are you hoping to obtain funding?
Immediately
Within 30 Days
1-3 Months
3-6 Months
6+ Months
No Specific Timeline
28. What type of assistance are you interested in? Check all that apply.
Grant Readiness Assessment
Grant Research/Matching
Grant Application Assistance
Grant Narrative/Writing Assistance
Business Plan Assistance
Funding-Use Budget Preparation
I'm not sure - recommend what's best
29. Is there anything else we should know about your business or funding needs?
Back
Next
FINAL ACKNOWLEDGMENTS
I understand that Purpose Redefined Business Solutions provides administrative, research, preparation, and/or application assistance and does not guarantee that I will qualify for, receive, or be awarded grant funding. Grant eligibility and award decisions are determined solely by the applicable funding organization.
I certify that the information I have provided in this questionnaire is accurate to the best of my knowledge. I understand that inaccurate or misleading information may affect my eligibility for grant-assistance services.
Client Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
For PRBS use: Recommended Next Step
Grant Ready
Needs Preparation
Not Ready Yet
This intake is designed as a pre-screening tool and does not constitute a grant application or a promise of funding.
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