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Montgomery County Spark Small Business/Non-Profit Grant

MONTGOMERY COUNTY SPARK GRANT FOR SMALL BUSINESSES AND NOT-FOR-PROFIT ORGANIZATIONS

Montgomery County designated $400,000 for Small Business and not-for-profit (501(c)3 and 501(c)6) organizations, with a cap set at $100,000 for not-for-profit businesses. Businesses and non-profit organizations will have to show that they have a need for the funding due to the impacts of COVID-19. This application is required to be considered for this grant funding.

2. Who is the Authorized Signature of the small business/nonprofit?

Small Business/Nonprofit Name

Authorized Signature Name

Title

Street Address

Apt/Suite/Office

City

State

Zip

Main Phone Number

Mobile Phone

Email Address

3. Applicant Type

4. Choose the category that best fits your nonprofit organization. Please choose all that apply.

4. Choose the category that best fits your nonprofit (501c6) organization. Please choose all that apply.

Please enter an 'other' value for this selection.

4. Choose the category that best fits your small business. Please choose all that apply.

4. Is the address above considered commercial or private?

5. If the main contact is different than above, please complete the information below.

Small Business/Nonprofit Name

Main Contact

Position Title

Street Address

City

State

Zip

Main Phone Number

Mobile Phone

Email Address

6. Is this small business/nonprofit part of a larger organization located outside of Montgomery County?

7. Please enter the information for the small business/nonprofit's main office.

Small business/Nonprofit Name

Owner/Executive Director Name

Position Title

Street Address

Apt/Suite/Office

City

State

Zip

Main Phone Number

Mobile Phone

Email Address

URL

7. Do you have a DUNS number? *This question is required.

8. What is your DUNS number?

8. If you do not have a DUNS number you can request one at https://fedgov.dnb.com/webform/index.jsp

This is required in order to receive federal funding. This typically takes 1-5 days to receive. You can submit this information once you have received it to TPurdon@actioncouncil.com.

Please enter an 'other' value for this selection.

8. What is the small business/nonprofit's FEIN, EIN, or Taxpayer ID#? *This question is required.

9. What is the small business/nonprofits's name as shown on the FEIN, EIN, or Taxpayer ID? *This question is required.

10. If you use a different name in the marketplace than listed above, please list the name you use here:

11. Is the small business/nonprofit registered with the Secretary of State? *This question is required.

12. Has the business/nonprofit already received, or will receive, CARES Act, EIDL, or PPP dollars outside this request? *This question is required.

Space Cell	Yes	No
PPP	PPP: Yes	PPP: No
EIDL - Loan Advance Grant	EIDL - Loan Advance Grant: Yes	EIDL - Loan Advance Grant: No
EIDL - Loan	EIDL - Loan: Yes	EIDL - Loan: No
CDBG-CV Grant	CDBG-CV Grant: Yes	CDBG-CV Grant: No
CDBG Loan	CDBG Loan: Yes	CDBG Loan: No
SBA Loan Deferral	SBA Loan Deferral: Yes	SBA Loan Deferral: No
Other SBA loan support program	Other SBA loan support program: Yes	Other SBA loan support program: No
HIRE Loan fund	HIRE Loan fund: Yes	HIRE Loan fund: No
Local Grant program	Local Grant program: Yes	Local Grant program: No

13. Please list the type and amount of funding the small business/nonprofit received or will be receiving.

14. Please indicate the number of employees, including yourself and/or the owner.

For small businesses/nonprofits who have employees other than an owner/executive director, please list the number of employees as indicated on the Form 941 filed in March or June 2020. Do not count 1099 contractors.

Full-Time Employees
Part-Time employees

15. Did you close due to state mandates or choose to close for health and safety reasons?

16. Please list the expenses for which you are requesting reimbursement.

Reimbursement can be requested for expenses incurred from March 1, 2020 - September 15, 2020.

	Cleaning/Sanitation expenses
	COVID related signage
	Equipment
	Fixed Assets
	Marketing
	Payroll
	PPE
	Other legitimate bills that were made difficult due to COVID-19

17. Please list the expenses for which you are requesting for future needs:

FUTURE EXPENSES are expenses incurred from September 15 - December 30, 2020 ONLY.

	Cleaning/Sanitation expenses
	COVID related signage
	Equipment
	Fixed Assets
	Marketing
	Payroll
	PPE
	Other legitimate bills that were made difficult due to COVID-19

18. If you listed "Other legitimate bills" above, please describe.

19. Are you proposing a collaborative project? If so, please email a narrative of the project to TPurdon@actioncouncil.com, as well as the brief description below.

20. If you are submitting a collaborative project, how much are you requesting for this project?

	Total Project Cost
	Total Request

20. What is the total amount you are requesting?

Reimbursements
Future Expenses
Collaborative Projects
TOTAL

21. Please describe the negative impact COVID-19 has had on your small business/nonprofit. *This question is required.

22.

The state of Kansas wants to ensure that SPARK funding assists in reaching vulnerable populations. If your small business/nonprofit serves any of these target groups, please check all that apply.

23.

I agree that the information I have provided is correct. I understand it will be necessary to sign a memorandum of understanding if this application is approved. The memorandum will include reporting requirements and will outline that if funds are misused, the approved entities will be responsible for returning the funds to the county.