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Portland Small Business Relief Fund Application
Small Business Relief Fund Application
Eligibility Requirements
Business name
*
Does the business serve as the primary source of income for owner?
*
YES
NO
Is your principal place of business located in the City of Portland?
*
YES
NO
IF NO: Do you have an active City of Portland Business License?
*
YES
NO
Was your business in operation and actively registered with the State of Oregon on or prior to December 31, 2019?
*
YES
NO
No, it’s not required because I do business under my own name / sole proprietor
Did you have 50 or fewer employees prior to January 1, 2020?
*
YES
NO
Have you experienced a decline in revenue since February 1, 2020 due to the COVID-19 public health and economic crisis?
*
YES
NO
In 2019, was your annual gross revenue less than $5 million? (Gross revenue means total sales before any money was taken out for taxes or other deductions)
*
SI
NO
Details about you and your business
Name (business owner)
First
Last
Are there multiple business owners?
*
YES
NO
Name(s) of other business owners:
First
Last
Name(s) of other business owners:
First
Last
Main contact email
*
Main contact phone number
*
Business address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
DEMOGRAPHIC INFORMATION - Business owner 1
What are your gender identities? (Select all that apply)
*
Woman
Man
Non-binary
Two Spirit
Choose not to identify
Prefer to self-describe
please self-describe your gender
*
What is your primary racial or ethnic identity?
*
Hispanic or Latino/a/x
Black or African American
Native American / Indigenous
Asian
Native Hawaiian or Pacific Islander
Middle Eastern / North African
White
Unknown / don't know
Choose not to identify
Prefer to self-describe (please describe)
please self-describe your primary racial or ethnic identity
*
American Indian or Alaska Native
American Indian
Alaska Native
Canadian Inuit, Metis or First Nation
Indigenous Mexican, Central or South American
Tribal Affiliation(s)Enrolled Member:
Tribal Affiliation(s)Descendant:
Asian
Chinese
Vietnamese
Korean
Hmong
Laotian
Filipino/a
Japanese
South Asian
Asian Indian
Other Asian
Black or African American
Black or African American
African (Black
Caribbean (Black)
Other Black
Middle Eastern / Northern African
Middle Eastern
North African
Hispanic or Latino/a/x
Hispanic or Latino/a/x Mexican
Hispanic or Latino/a/x Central American
Hispanic or Latino/a/x South American
Other Hispanic or Latino/a/x
Native Hawaiian or Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Micronesian
Samoan
Tongan
Other Pacific Islander
White
Eastern European
Western European
Slavic
Other White
ADDITIONAL IDENTITIES (OPTIONAL)
Do you identify as an Immigrant?
YES
NO
Do you identify as a refugee?
YES
NO
Do you identify as LGBTQIA+?
YES
NO
Do you identify as a person with a disability?
YES
NO
Do you identify as a veteran?
YES
NO
DEMOGRAPHIC INFORMATION Business owner 2
What are your gender identities? (Select all that apply)
*
Woman
Man
Non-binary
Two Spirit
Choose not to identify
Prefer to self-describe
please self-describe your gender
*
What is your primary racial or ethnic identity?
*
Hispanic or Latino/a/x
Black or African American
Native American / Indigenous
Asian
Native Hawaiian or Pacific Islander
Middle Eastern / North African
White
Unknown / don't know
Choose not to identify
Prefer to self-describe (please describe)
please self-describe your primary racial or ethnic identity
*
American Indian or Alaska Native
American Indian
Alaska Native
Canadian Inuit, Metis or First Nation
Indigenous Mexican, Central or South American
Tribal Affiliation(s)Enrolled Member:
Tribal Affiliation(s)Descendant:
Asian
Chinese
Vietnamese
Korean
Hmong
Laotian
Filipino/a
Japanese
South Asian
Asian Indian
Other Asian
Black or African American
Black or African American
African (Black
Caribbean (Black)
Other Black
Middle Eastern / Northern African
Middle Eastern
North African
Hispanic or Latino/a/x
Hispanic or Latino/a/x Mexican
Hispanic or Latino/a/x Central American
Hispanic or Latino/a/x South American
Other Hispanic or Latino/a/x
Native Hawaiian or Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Micronesian
Samoan
Tongan
Other Pacific Islander
White
Eastern European
Western European
Slavic
Other White
ADDITIONAL IDENTITIES (OPTIONAL)
Do you identify as an Immigrant?
YES
NO
Do you identify as a refugee?
YES
NO
Do you identify as LGBTQIA+?
YES
NO
Do you identify as a person with a disability?
YES
NO
Do you identify as a veteran?
YES
NO
ABOUT YOUR BUSINESS
Is your business family-owned and operated?
*
Yes
NO
Family-owned businesses are majority owned by a member or members of a single family. They are actively involved in the day-to-day management of the businesses and potentially employ fellow family members.
How long have you been in business?
*
Less than 1 year
1-3 years
4–5 years
6–10 years
More than 10 years
How many locations does your business have within the City of Portland?
*
1
2
3 or more
Is your business a franchise operation?
*
Yes
NO
Do you rent or own your space(s)? (If you have multiple locations, select the option for that best applies.)
*
Rent
Own
Which of the following best describes your business? (Select one):
*
Catering
Childcare
Cleaners
Construction
Convenience store / bodega
Event venue
Gym / fitness
Health care and social assistance
Hotel / motel
Laundromat
Manufacturing
Personal services (salon, barber shop, massage, wellness, etc.)
Professional services (insurance, accounting, legal, etc.)
Property management
Restaurant / bar / brewery / café / food cart
Retail
Technology
Transportation and warehousing
Wholesale
ABOUT YOUR EMPLOYEES
How many employees do you have today? (Include yourself.)
*
1 including myself
2–5
6–9
10–25
26 or more
Which of the following best describes the impact to your workforce during the pandemic
*
Added employees
Maintained the same number of employees
Reduced employee hours, but did not lay off employees
Temporarily laid off employees
Permanently laid off employees
How many employees were laid off due to the pandemic?
*
1
2-5
6-9
10-25
26 or more
IMPACT TO YOUR BUSINESS
Is your business currently open and operating?
*
Yes
NO
Are you planning to re-open?
*
Yes
NO
How much has your revenue declined due to the public health and economic crisis?
*
10% or less
10% - 30%
30 - 50%
50 - 75%
Greater than 75%
Given current conditions, how long do you estimate your business can continue operating?
*
Less than 1 month
1 – 3 months
3 - 6 months
6 - 12 months
More than 12 months
How has the pandemic affected your business?
*
How are you adapting to the new environment? (select all that apply)
*
Transition to a mobile workforce
Increasing digital presence (examples: marketing and social media, online sales platform)
Changing business operations
Changing physical space (examples: to-go services, curbside pick-up, expand into the right of way, etc)
Changing business model
I have not made any changes
Other
IF OTHER (Please specify)
*
Please select the following programs from which you have received financial support. Select all that apply
*
Paycheck Protection Program
Economic Injury Disaster Loan
Other federal assistance
APANO grant
Small Business Relief Fund – grant or loan (Prosper Portland)
Portland Small Business Program for Utility Relief (City of Portland)
I have not received any public funds
Raza Development Fund
Other
IF OTHER (Please specify)
*
Have you experienced racial, gender or other biases based on your identity from a lender, financial institution, or landlord in the past?
*
YES
NO
How will you primarily use the grant funds?
*
Make payroll
Pay late rent or mortgage
Pay other business expenses
Adapt business model or other operational changes
Make physical property improvements to support pandemic public health requirements
Grants will need to be used for expenses incurred between March 1 through December 30, 2020.
Please select the providers with whom you have an existing relationship, if any:
Mercado Empresarios: Café y Pláticas, One on One Business Advising, One on One product development, Mercado Cocina Tenant, Mercado Tenant.
Black United Fund
Craft3
Division Midway Alliance
Historic Parkrose
Mercy Corps Northwest
Micro Enterprise Services of Oregon (MESO)
NAYA
Livelihood NW
Irco
Apano
Hispanic Metropolitan Chamber
None of the above
TERMS & CONDITIONS
• I understand that if I am selected for grant funding, Hacienda CDC will share my application and information with Prosper Portland.
*
YES
• I understand that Hacienda CDC and the City of Portland may publish details of applicants, including general demographic information, business type, and the ways the grant will support a business. The names of all businesses receiving grants will be published.
*
YES
• I understand that this application is subject to public records law and information may be shared with outside sources.
*
YES
• I understand and agree that Hacienda CDC and/or Prosper Portland may request further information / documentation if I am selected for a grant award.
*
YES
• I certify that (1) all of the information I have provided in this application is true, and (2) neither I nor my business are debarred (legally prohibited) from doing business with the federal government or a state/local government.
*
YES
If selected, I understand I could be asked to work with Hacienda CDD and/or Prosper Portland to tell my story and share how this grant helped my business during the pandemic.
*
YES
Do you want to sign up for our email list and receive information about additional resources for your business?
*
YES
NO