STEP 2019-2020 Financial Assistance Award Application

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* 1. Please provide the following applicant information:

Your Name: *

Company Name: *

Address: *

Address 2:

City/Town: *

ZIP:

Email Address: *

Phone Number: *

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* 2. If different from the previous question, please provide the following information about the company Owner/President:

Full Name:

Address 1:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Email Address:

Phone Number:

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

Full Name:

Email Address:

Phone Number:

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* 4. Company website:

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* 5. Federal EIN:

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* 6. Year established:

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* 7. Number of employees in Maine:

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* 8. Sales from exports (%):

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* 9. Is this business an affiliate or subsidiary?

Yes

If yes, please provide name and location of parent company:

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

Yes

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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. Proposed dates:

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

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* 14. Provide the name, address, email, and phone number for organization conducting matchmaking services. (NOTE: Organization must be U.S. Department of Commerce or other contractor pre-approved by MITC.) - OR - Provide the name, address, email and phone number for individual or organization providing training services.

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

International Business Development

Export Skills Development

Export Marketing Assistance

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* 16. Please provide the total estimated project cost.

Travel cost (airfare, lodging, in-market ground transportation)

Non-travel cost (business matchmaking, exhibit booth space, shipping, interpretation or translation, etc.)

Total cost (travel + non-travel costs from above)

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* 17. Have you received a previous STEP Financial Assistance Award for this activity?

Yes

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* 18. Would you describe your company as a "new to export" business, having little or no previous export experience?

Yes

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* 19. Is your business currently exporting to one or more markets and:

Expanding into new country markets

Expanding into a new region or new segment or new product line within an existing market

N/A

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* 20. The U.S. Small Business Administration (SBA) would like to give eligible small business concerns the opportunity to expand your knowledge and resources of other programs that are offered by the agency. Please check the appropriate box if you would like for your company's name and contact information to be shared with other programs offered by SBA. Your choice to participate or not will not change the status of your participation with STEP. SBA's aim is strictly to share information about other opportunities with you.

Yes

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. STEP Financial Assistance Award funds will only be used for those activities included in the project budget.

4. At least 51% of the manufactured value of the product or the performance value of the service will be produced in Maine.

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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* 21. 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, except for reporting purposes to the US Small Business Administration.

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