MBEmpower Fund Application; Funded by

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This survey is meant to identify how your business has navigated financial resources during the pandemic. If you are selected to receive a portion of the MBEmpower Fund, it will be used for certification/re-certification purposes only.

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* 1. Contact Information

Full Name

Company

Title

MBE Certification Number

Email Address

Phone Number

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* 2. How has or how will COVID-19 affect your business?

Business as usual

Most employees working remote

All employees working remote

In danger of closing down

Closed down

Other (please specify)

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* 3. How long have you maintained MBE certification with SCMSDC?

10+

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. Select all relief funds for which you were approved.

Paycheck Protection Program (PPP)

Economic Injury Disaster Loan (EIDL)

Express Bridge Loan

SBA Debt Relief

Other

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* 5. If funding is approved, would you be willing to provide a statement of thanks to our supporting corporate members & MBEs?

Yes

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* 6. Please upload any supporting documents that may instruct our decision.

Bank statements, past due notices, etc.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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MBEmpower Fund Application; Funded by

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* 1. Contact Information

Question Title

* 2. How has or how will COVID-19 affect your business?

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* 3. How long have you maintained MBE certification with SCMSDC?

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* 4. Select all relief funds for which you were approved.

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* 5. If funding is approved, would you be willing to provide a statement of thanks to our supporting corporate members & MBEs?

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* 6. Please upload any supporting documents that may instruct our decision.

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* 7. SCMSDC continues to serve our constituents in the manner to which you are accustomed. Please comment on how SCMSDC can support your company.