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Micro-Grant Program

  1. If you are required to hold a certification or license to operate your business.

  2. Not required for submission however it is required for payment. City will assist.

  3. Identify the organization that issued your certification/ license.

  4. Best number to reach you at

  5. Briefly describe the financial impact of the Safer at Home order on your business as it relates to COVID-19 - 2500 character limit

  6. If self-employed, enter 0 (zero)

  7. Estimated loss in revenue in March, April, and May.

  8. Please list what type of business you operate

  9. As of submisson of this form, has the business received any other federal, state, or local assistance?*

  10. Did you experience a mandatory closure and/or a significant change in operations?*

  11. Did you recieve any other income from any other type of employment in the past 12 months?*

  12. If yes, was that income greater than 50% of your income in the previous 12 months?*

  13. Electronic Signature Agreement

    I hereby certify that the data provided above is true and correct to greatest extent of my knowledge. I further certify that I understand and acknowledge the following:


    1) That the City of Milton reserves the right to verify the data provided above,
    2) The City of Milton will reject all requests that do not meet the requirements as approved by City Council,
    3) This request will be processed in the order it was received and as quickly as possible,
    4) The submission of the application does not guarantee any funding,
    5) Any information found to be fraudulent may result in the repayment of this grant,
    6) Recipients will be required to complete a W9 when picking up a check.
     

  14. Leave This Blank:

  15. This field is not part of the form submission.