Industry Certification Grant Application

Qualifications:

Business must have a minimum of seven Full Time Employees whose average pay is equal to or greater than $30,000 and offer medical benefits where the employee pays no more than 50% of premiums.

Contact Information

Company name*

First name*

Last name*

Street address*

City*

State/Region*

Postal code*

Business owner email address*

Business phone number*

Business Owner mobile phone number*

Website or Facebook URL*

N/A if not applicable

Business Information

Business opening date*

Month/Day/Year

How long has business been operating under current ownership?*

Number of full time employees*

Minimum of 7 full time employees required.

Number of part time employees*

Average wage of all employees*

Include average $/hour or annual salary

Project Information

Tell us about the certification the business is seeking assistance with*

Will this certification increase the number of jobs? If so, how many?

Estimated total cost of certification expenses?*

May include audit costs, travel and lodging expenses for auditors or consultants, consultant fees, certification and application fees.

Will this certification result in increased sales?

If this project will increase sales, provide the sales projection for the next two years.

*Submitting this form will begin the process of applying for the Industry Certification Grant. Note you will be required to submit the following documents as you proceed through the application process:

Last 12 months profit and loss statement
Current balance sheet
IRS Form W9, signed and dated