Application Form | NY Small Business COVID-19 Grant Program

This is a sample application for translation viewing only.

This is not an application and you cannot use this to apply.

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First Name
Last Name
E-Mail
Confirm E-Mail
Owner Cell Phone
Confirm Owner Cell Phone
Business Name
Zip Code of Business
Consent
I accept the SMS/Text Policy
Owner details
Owner First Name
Owner Last Name
Email
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Owner Date of Birth
MM slash DD slash YYYY
Owner Social Security (#SSN)
% of Ownership
Consent
I accept the Terms and Conditions
Business Information
Business Name
DBA (Doing Business As)-[ Note -If no DBA type NONE ]
Business EIN (Only digits, Cannot contain Special Characters or Spaces)
Business Phone #
Business Type
State of Incorporation
State / Province / Region
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date Business Established
MM slash DD slash YYYY
Business Website URL
How can we help you?
Purpose of grant
Amount Requested
Will This Grant Create More Jobs?
Annual Revenue
# of Full-Time Employees
# of Part-Time Employees
# of Jobs to be Created (during 2021)
# of Jobs Retained
Business demographics
Who is your customer base?
What does your business do?
What type of business is it? *
Tell us more.
NAICS Code
Click here to find your NAICS code
Woman Owned Business
Veteran
Disabled
Race
Ethnicity
Franchise
Rural
Disclosures
Is your business 51% Minority or veteran-owned? (Minority/Person of Color-Owned Small Business” means the following racial or ethnic groups (as identified by the applicant): African-American/Black, Asian, Native American or Alaska Native, Native Hawaiian or Pacific Islander, or LatinX/Hispanic.)
What was the gross revenue for your business for April 1st, 2019 - September 30th, 2019?
What was the gross revenue for your business for April 1st, 2020 - September 30th, 2020?
Is your business currently in need of business advising or technical assistance services?
Is your business currently in need of a business loan?
During the last 9 months, has your business received any COVID-19 related emergency grants?
If YES, what was the name of the program in which you received funding?
If YES, what is the total amount in relief funds that you have received to date?

This is a sample application for translation viewing only.

This is not an application and you cannot use this to apply.

Let's get started with your application

Owner details

Business Information

How can we help you?

Business demographics

Disclosures

This is a sample application for translation viewing only.

This is not an application and you cannot use this to apply.