Emergency Economic Relief Microgrant Application

Business Name *

Owner Name *

Please indicate ethnicity of owner *

Industry/Business Type *

Phone Number *

Email Address *

Website/URL

Annual Revenue (estimated) *

Address *

Years in Operation *

Number of Employees *

Minority Owned? *

FWHCC Member *

Woman Owned *

Have you applied for other business financial assistance? *

Have you received other business financial assistance? *

Has your business been directly impacted by the COVID-19 economic crisis? Please be sure to elaborate and provide sufficient information about your business so that need can be determined. *

If you were to be awarded a grant, please explain how the funds would be used. (Example: Rent Bill, Utility Bill, Payroll, etc.) *

Any additional information you would like to share? *

Please check off the box below to consent to your information being shared with Cargill, Incorporated and Rumba Meats, the provider of this grant opportunity (together with USHCC, "Sponsors"), and to being contacted by the Sponsors for communications and media purposes. You further grant the Sponsors the right to use certain information about you in connection with the Content, including your name, image, and other profile information, so long as you have made it publicly available on any Sponsors' website at any time in connection with the Rumba Meats Grant Application, such use will include, without limitation, use in the exhibition, broadcast, distribution, advertising or promotion of the Rumba Meats Grant or any other grants offered through the Sponsors' website. *

Yes, we consent.

No, we would not be open to media opportunities.

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