Small Business Safety & Cleanliness Grant

Address *

Organization Name *

How did you hear about this program? *

Full Name *

Job

Email Address *

Phone Number *

Additional Contacts

What type best describes your organization? *

Organization Tax Classification *

Years in Operation *

Organization Mailing Address *

How many employees does your organization have? *

Organization Website

Please describe your organization in a few sentences. What are your origins, purpose, mission, and/or goals? *

Have you previously received a grant from the City of Bloomington? *

Proof of address (utility bill, lease, etc) *

Does this project require a Certificate of Appropriateness due to historic designation or documentation that the Historic Preservation Program Manager has confirmed that you do not need a COA (such as a copy of an email)? *

Does your organization own or lease your facility? *

Total Project Cost *

Total Funding Requested *

Basic Project Details *

Project Start Date *

Project End Date *

Are you applying for any other grants or sources of funding for your project, from the City of Bloomington or otherwise? Please describe the sources, amounts, and funding status.

Please upload photos of the project prior to improvements or "before" pictures. *

Please upload quotes, invoices or receipts for the improvements. *

How would participating in this program help address the needs of your organization and facility(ies)? *

Please upload a document or spreadsheet with a simple project budget, including your matching funding. *

Application Signature *