City of Richland Covid-19 Relief Grant Application ⋆ Mercy Corps Northwest

Eligibility Questions

These questions will determine your eligibility for this grant. Please read the instructions carefully.

Is your business address, as listed on your business license, located within the city limits of Richland?*

Is your business any of the following?*

The following are not eligible for this grant.

1. Adult entertainment, gaming, liquor, tobacco or Cannabis stores
2. Passive real estate investments, pyramid business structures, franchises
3. Pawn shops
4. Non-profits

Other business requirements - do all of the following requirements apply to your business situation?*

1. Business license active in WA (licensed obtained on or before 7/1/2019)
2. 5 or fewer employees including owner before Covid
3. Have a business bank account or if business is sole prop. can use personal checking account

Yes
No

Has your business experienced a significant decline in revenue?*

We require businesses to have a significant decline in revenue due to Covid-19 and lockdown impact, based on prior year tax return, we are prioritizing those with 25% or more

Yes
No

If you have 5 or fewer employees only, is your household income 80% or below city average income?*

Based on the number of people in your household, is your income at or below the income limits in the chart below? This is a requirement for eligibility.
Clark County Census Tracts

My business has 6-20 employees and the annual wage of 51% or more of my employees is within the low-to-moderate income levels (as seen in chart)
My business has 5 or fewer employees and I am under the income limits
I do not qualify

Eligibility

Unfortunately you do not meet the eligibility requirements for this grant. Thank you for your interest.

I. Business Information

Business Name (as it appears on your state business license)*

When did you start your business? (Estimate is fine)*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Email*

This is the email we will use for all communications. Be sure it is an email address you can check easily.

Enter Email Confirm Email

Business Phone*

Unified Business Identifier (UBI)*

A UBI number is a nine-digit number that registers you with several state agencies and allows you to do business in Washington State. A UBI number is sometimes called a tax registration number, a business registration number, or a business license number.

Business Website

If applicable, please include weblinks to your business website or social media

If you have any social media accounts from your business, please list them below.

Business Facebook page:

Business Instagram account:

Business Twitter account:

Business Type*

Please select the industry you are in

In a few sentences, describe your business and the service or product it provides.

Is your business place-based?*

A business is placed-based if it is located outside the home where the owner resides. Ex. Market, brick-and-mortar

Including yourself, how many full-time paid employees do you have?*

Counting yourself and all full-time employees, as of the date of this application.

How many part-time paid employees do you have?*

Counting all part-time employees, temporary workers, contractors, interns, etc., as of the date of this application

II. Coronavirus Impact on Business

Revenue impact - by what percent has your business revenue declined due to Covid-19 and lockdowns?*

Please enter numbers only (ex: if you have 28% loss of revenue, enter 28) and provide your best estimate, information will be verified.

Please enter a number from 0 to 100.

How much time before you run out of savings and have to use debt to pay for expenses?*

Has your business been impacted by COVID-19 (also known as the Coronavirus)? If yes, please describe in the box below..*

We want to understand the impact of Coronavirus on your business and any information you can provide is helpful. This could include lost revenue or sales, canceled events, the number of employees laid off, lost customers, etc.

Please estimate your revenue impact comparing Q3 2019 to Q3 2020.

What is the likelihood of permanently closing the business?*

High
Medium
Low

Business Owner Personal Information

Your Full Legal Name*

First Last

Preferred Name

Your Home Address*

Street Address City State ZIP Code

What is your personal residence status?*

Phone*

Email*

At Mercy Corps Northwest we encourage individuals of all backgrounds to apply for our programs but particularly welcome people from traditionally underserved/undercapitalized populations such as those who identify as women and minorities, domestic violence survivors, as well as those who are transitioning from incarceration and the homeless/housing insecure.

All data and information collected will remain anonymous and confidential and is used strictly for purposes of the application selection process.

Gender*

Ethnicity*

Do you identify as Hispanic or Latinx?*

Yes
No

Do you identify as an immigrant or refugee?*

Please note that U.S. citizenship is not required to receive this grant

What is your country of origin (in what country were you born)?*

What is your preferred language?*

This is not required but will be helpful in responding to your questions and processing of the application.

Are you comfortable speaking English with one of our staff?*

This is not required but will be helpful in responding to your questions and processing your application.

Yes
No

Do you identify as a US veteran?*

Yes
No
Prefer not to say

Do you identify as having a disability?*

Yes
No
Prefer not to say

Have you ever been incarcerated?*

All individuals are eligible to apply regardless of their level of involvement with the justice system.

Yes
No
Prefer not to say

Are you a single parent?*

Yes
No
Prefer not to say

Do you have children under the age of 5 in your household?*

Yes
No
Prefer not to say

Household Size, Income, and Assets

How many people live in your household (including yourself)?*

Please include those you would include in your family or those in which you share financial dependency. Do not include roommates.

For the following questions, household income refers to any income for the applicant and other members of the household (ie spouse) that share financial dependency. Please estimate if needed.

Be prepared to upload your 2019 and 2020 household tax returns at the end of this application. We may ask for additional paperwork such as W-2s, pay stubs, and/or bank statements to verify.

If the question does not apply to you please put "0".

What is your household's current monthly gross salary or wage?*

Gross salary or wage is any income your household receives from an employer/s, pre-tax. If this question does not apply to you please put "0".

What is your household's current monthly self-employment income?*

Self-employment income is what your household pays itself (owner's draw) from the business. If this question does not apply to you please put "0".

What is your household's current monthly business net income?*

Business income is the net profit after self-employment income and business expenses. If this question does not apply to you please put "0".

What is your household's current monthly investment income?*