City of Terre Haute and United Way
Small Business Retention/Expansion Grant Program
Project Qualification Survey

Thank you for your interest in the Small Business Retention/Expansion Grant Program. As the first step, each applicant will complete a Project Qualification Survey outlining their basic funding request and business basics and provide Business Eligibility documents.

Review of these documents will determine whether or not a business is eligible to apply for funding. The answers to these questions will not be evaluated based on their response, but rather to ensure that answers align with the goals of the funding and that the business qualifies to fully apply. This will help potential applicants avoid developing lengthy proposals which are not competitive. It will also potentially reduce the number of applicants submitting full proposals to a manageable size for thorough review.

If the Project Qualification Survey doesn’t align with eligible funding opportunities, varies significantly from the grant purpose and outcomes, or if any of the requested Business Eligibility documents are not available and submitted, the applying business will not be allowed to submit a full application and will be removed from the process and notified of the decision.

There will be two rounds of review for Project Qualification and Business Eligibility. Early deadline is May 16, 2024 at 5:00 pm with the final deadline of June 27, 2024 at 5:00 pm. All businesses only need to apply once by the final deadline. Those that are deemed ineligible after the first review are able to resubmit by the final deadline if their project can be revised or they can remedy disqualification issues.

If you have questions please reach out to the United Way of the Wabash Valley office at 812-235-6287 or info@uwwv.org.

Question Title

* Name of business

Question Title

* Address of business location requesting funds

Question Title

* Business owner information

Name

Phone number

Question Title

* Point of contact for funding, if different than owner.

Name

Title

Phone Number

Question Title

* Current employee count distinguishing between full and part time employees.

Question Title

* Date business began operation (month/year)

Question Title

* Provide a short introduction to business and its overall goals.

Question Title

* Amount of funding requested - The funding amount requested here is not binding and can be adjusted if the business is selected for a full application. If there is an adjustment in funding amount the applicant will be asked to provide an explanation of the need to change the requested amount.

Question Title

* Provide a general breakdown of the intended use of the funds.

Question Title

* Is this funding request part of a larger project? If so, what is the overall project budget? Please highlight any additional outside funding being utilized.

Question Title

* Please indicate which of the below goals this funding will help your business achieve. (Please select all that apply)

Retain existing businesses

Retain existing employees

Increase revenue

Increase employees

Question Title

* How will this funding help your business achieve the above goal(s)? For each response, please include which goal(s) you are working toward and provide the projected outcome that will result from the funding.

Question Title

* Is the business locally owned and operated?

Yes

Question Title

* Is the business a subsidiary of a larger corporation?

Yes

If yes, please explain.

Question Title

* Is the business a publicly traded company?

Yes

Question Title

* Is the business in good standing with the Indiana Secretary of State as a Business Entity or if a sole proprietorship does the business have a certificate of assumed business name or doing-business- as (DBA) form record from the County Recorder?

Yes

If no, please explain.

Question Title

* Are you a minority, women or veteran-owned business?

Yes

If yes, have you received state or federal MBE, WBE, or VOSB certification or are you in the process of receiving such certification?

Question Title

* Is your business facing any pending litigation or legal action?

Yes

If yes, please explain.

Question Title

* Has your business been debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs as noted in the attached SBA ineligible loan link (not eligible for SBA loans)?

Yes

Business Eligibility Documents to be Attached to Survey