Thank you for your interest in the Small Business Emergency Assistance Grant. At this time, we are no longer accepting applications. However, you may contact the following organizations who may help you with funding options in the future as they become available:

Blue Hills Civic Association, Vickie Gallon-Clark, (860) 560-7360, clarkv@bluehillscivic.org
Upper Albany Main Street, Marilyn Risi, (860) 768-5747, risi@hartford.edu
Upper Albany Merchants Association, Fay Santouse, (860) 532-9574, bandlcleaningservices@gmail.com
Spanish American Merchants Association (SAMA), Julio Mendoza, (860) 278-5825, julio_mendoza@samact.org
Entrepreneurial Center, University of Hartford, Sheri McMillen, (860) 768-5652, mcmillen@hartford.edu

Hartford Emergency Small Business Emergency Assistance Grant Program

Please make sure all required fields are completed. Prepare and verify your documents for upload by making sure you can view them on your device before you upload them. If you have any questions regarding how to complete this form, please contact a list of available partners HERE. Should you have a technical problem submitting the form, please email support@hartfordgrant.com. This grant application process will close on Monday, May 11th at 6:00 p.m. Google Chrome browser is recommended to avoid technical problems.

Asegúrese de completar todos los campos obligatorios. Prepare y verifique sus documentos para cargarlos asegurándose de que pueda verlos en su dispositivo antes de cargarlos. Si tiene alguna pregunta sobre cómo completar este formulario, comuníquese con una lista de socios disponibles AQUÍ. Si tiene algún problema técnico al enviar el formulario, envíe un correo electrónico a support@hartfordgrant.com. Este proceso de solicitud de subvención se cerrará el lunes 11 de mayo a las 6:00 p.m. Se recomienda el navegador Google Chrome para evitar problemas técnicos.

Section 1: Applicant Information

Business Name: *

Business Address - Street Address: *

Business Address - City: *

Business Address - State: *

Business Address - ZIP Code: *

Business Phone: *

Business Email: *

Date Business Established: *

Tax Identification Number(TIN): *

DUN # (optional):

Business Structure: *
Sole Proprietorship
Limited Liablity Corp
Corporation
Other
Business Structure:

Type of business: *
Food/Restaurant
Retail
Service
Contracting/Construction
Day Care
Other
Type of business:

Briefly describe business: *

2019 Gross Revenues: *

2019 Net Profit/Loss: *

Total Number of Employess: *

Number of Women: *

Number of Men: *

Number of Minorities: *

Section 2: Owner Information

1st Owner

Owner Name: *

Owner SSN: *

Owner Phone: *

Owner Address - Street Address: *

Owner Address - City: *

Owner Address - State: *

Owner Address - ZIP Code: *

Owner Gender Identification (not required):

Owner Ethnicity (not required):

2nd Owner (not required)

Owner Name:

Owner SSN:

Owner Phone:

Owner Address - Street Address:

Owner Address - City:

Owner Address - State:

Owner Address - ZIP Code:

Owner Gender Identification (not required):

Owner Ethnicity (not required):

Section 3: Underwriting Concerns

Have you applied for any funding from Federal Programs, (PPP or SBA), State of CT, HEDCO, LISC or COVID-19 related support programs? *
Yes
No

Have you been approved or received any funding? *
Yes
No

If yes, how much were you awarded, from which program? How much were you awarded? From which program?

Does the Business currently owe Federal or State taxes? *
Yes
No

Do the Business currently owe taxes to City of Hartford? *
Yes
No

Is the Business currently operating? *
Yes
No

Has the Business suffered an economic injury (losses) due to the COVID-19 Pandemic? *
Yes
No

Please describe the economic injury (losses) below: *

Describe how the grant will be used, if approved

Expense/Bill 1 * Amount Actual/Estimated 1 * Documentation Provided 1 * Upload documentation file 1 *