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PPA Region 13 - Armstrong, Butler, Clarion, Jefferson & Indiana Counties

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* 1. Applicant Name:

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* 2. Applicant Phone:

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* 3. Applicant Email:

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* 4. Applicant Address, City, State, Zip:

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* 5. Business Legal Name (if applicable):

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* 6. Business FEIN (if applicable) or owner SS#:

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* 7. Business Address, City, State, Zip (if applicable):

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* 8. Form of Business (if applicable):

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* 9. Stage:

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* 10. Select which creative industry best describes your business. Select only one. Descriptions of each industry can be found in the guidelines.

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* 11. Describe the proposed activities to be supported by the grant and intended outcome:

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* 12. Grant amount Requested:

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* 13. Describe the use of grant funds:
for example:
Paperclip Printing - 500 brochures - $1,000
Triangle - Credit Card reader - $300
Joe Smith workshop - E-commerce Website Development - $300
Amce Trade Show Registration - $250
123 Sign Company - 2 banners, 4 signs - $150

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* 14. Representations and Warranties:
 The Applicant makes the following representations and warranties to United Way of Clarion County, each of which shall be deemed to be a separate representation and warranty, all of which have been made for the purpose of inducing United Way of Clarion County to approve a grant award, and in reliance upon United Way of Clarion County will make its determination of the Applicant’s eligibility for a grant award. Effective as of the submission of this application, the Applicant hereby represents and warrants to the best of the Applicant’s knowledge and belief that:
-All information provided in this application and any attachments hereto is true and correct.
-Applicant is at least 18 years of age and has been a resident of Pennsylvania for at least twelve months preceding the submission of this application.
-Applicant is a creative entrepreneur operating or intending to form an eligible creative business as defined in the Creative Entrepreneur Accelerator Grant Program guidelines.
-If the Applicant operates an eligible creative business, the business had gross revenue of less than $200,000 for the period covered by the business’ most recently submitted annual filing to the Internal Revenue Service.
-Applicant has the power to engage in all transactions contemplated by this application.
-There is no suit, action or proceeding pending or, to the knowledge of the Applicant, threatened against or affecting the transactions contemplated by this application before or by any court, administrative agency, or other governmental authority, or which brings into question the validity of the transactions contemplated hereby.

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* 15. Attachments: Business that plan clearly demonstrates:
-Understanding of product or services
-Understanding of target consumer or audience
-Plan to reach target audience or consumer
-Clear budget for one year of operation using the funds (Entire business budget, not just grant funds)
-Goals, benchmarks, and metrics to evaluate success
-Proposed grant-supported activities will help grow audience/revenues
-The proposed use of grant funds is appropriate

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* 16. Authorization for Release of Information:
I consent for United Way of Clarion County to release/receive information for the purpose of determination of eligibility, coordination of services, and verification of required activities only as it relates to the Creative Entrepreneur Accelerator Program.
I understand that this consent is valid for 1 year from the date of my electronic signature and submission of this application.
I acknowledge that I may withdraw this permission at any time by contacting United Way of Clarion County.

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* 17. Applicant's Electronic Signature & today's date

0 of 17 answered
 

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