OEA 2018-2019 Grant Application

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* 1. Please provide the following applicant information:

Your Name: *

Company Name: *

Address: *

Address 2:

City/Town: *

State:

ZIP:

Email Address: *

Phone Number: *

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* 2. Please provide the following information about the company Accounting/Finance contact:

Full Name:

Email Address:

Phone Number:

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* 3. Company website:

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* 4. Federal EIN:

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* 5. Year established:

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* 6. Number of employees in Maine:

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* 7. Is this company an affiliate or subsidiary?

Yes

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* 8. Are the principal operations of this company located in Maine?

Yes

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* 9. Brief description of company’s products/services and intended market development:

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* 10. Indicate the appropriate category for the activity. (Only one category per application. Please submit separate applications to request funding in more than one category.)

Market Research and Diversification Assistance

Compliance and Certification Assistance

Trainings and Industry Events

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* 11. Project description: Briefly describe the project for which you are requesting funds. (NOTE: Please submit separate applications for each project. Only one activity per application is permitted. A total cost estimate for the activity will be required below.)

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* 12. How will this project support your growth and diversification strategy?

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* 13. Proposed dates for project: (NOTE: All projects must be completed by May 31,2019.)

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* 14. Provide the name, address, email, and phone number for the organization conducting the market research, certification, training, or other grant related service.

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* 15. Please provide the total estimated project cost.

Certification

An officer of the company must submit this application. By submitting this application, the applicant certifies that:

1. To the best of my/our knowledge, the data in this application is correct and that supporting documentation will be available to MITC for review upon request.

2. I/we understand that submitting false or misleading information may result in being found ineligible for reimbursement and permanent disqualification from any future use of this program.

3. OEA Grant funds will only be used for those activities included in the project budget.

4. Your company meets the eligibility requirements of an “Eligible Defense Company” as defined by the OEA 2018-2019 Grant Self-Certification Form.

5. I/we understand that MITC will conduct confidential surveys following the completion of the activity and at 6 and 12 months and agree to answer those surveys in a timely manner.

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* 16. Pursuant to MITC’s enabling statute (10 MRSA 107-B, section 945-J), certain information may be exempt from FOAA requests upon request. As this application and underlying project meets the statutory definition of “proprietary information”, i.e. “trade secret or production, commercial, or financial information the disclosure of which would impair the competitive position of the center or the person submitting the information and would make available information not otherwise publicly available,” I/we request that any information regarding this application remain confidential.

I certify that the information provided is truthful and accurate, and my contact information below shall serve as my electronic signature.

First and Last Name

Job Title

Date