Eligibility for MBA Program Is your business's physical location within Walla Walla County, Columbia County, or the City of Milton Freewater? If your business is in the idea stage, will it be located within these three areas?* Businesses must have a physical location (as verified by address listed on business license) in one of these locations to be eligible for the MBA Program.
If you are an existing business, does your business currently have 5 or fewer employees, including owner(s), full-time employees, and part-time employees?* This grant is only available for businesses that have 5 or fewer employees.
This grant has income eligibility requirements. Are you willing to submit the documents required to verify that your household falls under the gross income limits?* We require bank statements, proof of income, and other documents for ALL members of the household (not just the applicant) that share financial dependency.
Participating in a Business Foundations course and other educational offerings provided by MCNW is a required part of the MBA Program.* These courses and seminars are offered during the 6-month savings period.
The Business Foundations course will start in the spring of 2021. This 6-week course is held once a week for 3 hours each week, and in case of in-person classes, food and childcare are provided free of charge. Generally, this class is held on a Friday evening or Saturday morning depending on instructor availability.
The Basic Accounting class is a 6-week course held once a week for 2 hours each week. This course will start after the Business Foundations class ends.
The Master Your Credit Seminar is a one time 3-hour seminar which includes 1-on-1 mentoring with a volunteer credit counselor. Generally, this one time seminar is held during a weekday evening.
Please indicate when you are available. The class will be held on one of the two options, not both. This question is to gauge what works best for the most people.
If you answered “No” to any one of the previous questions or are not available for the education courses, your business is not eligible to be considered for this grant. If you have any questions about your eligibility, you can reach out to us at [email protected] . Contact Information Applicant's legal name* Legal name as listed on your ID or other legal documents
First
Middle
Last
Preferred name If different than first name
Date of birth* Applicant must be at least 18 years old at time of enrollment (March or April 2021).
Date Format: MM slash DD slash YYYY
Home address*
Primary phone number*
Alternate phone number
Personal email address* Please put N/A if you do not have an email address. This email will be used for official communication.
Household Employment and Income "Household" is defined as all individuals who share the space they use for eating and living together, separate from individuals outside of the household. Roommates, who split expenses and eat separately from each other, typically do not consider themselves as part of a household.
How many people live in your (applicant's) household?* Please include yourself.
Household members and income* Please list the name, date of birth, and relationship to you (wife, husband, partner, son, daughter, etc.) of all members of your household (including yourself). Also, please estimate the amount of money they earn each month from all sources (self-employment, gross wages, SSI, cash assistance, child support, unemployment, etc.).
If they do not earn income, put "0" in the "Income per month" section.
Click the '+" sign on the right to add a new line.
What is your current employment status (include all types of employment)* More than full time: +41 hours per week Full time: 35-40 hours per week Part time: less than 35 hours per week or seasonal Unemployed Unemployed due to COVID-19
How many jobs do you (applicant) currently have? Please count self-employment, gig work, or any jobs that bring in income.* Please list average hours worked per week for each job or gig.* Please include self-employment, gig work, or any jobs that bring in income.
The number of lines should be equal to the number of jobs indicated in the previous question.
Click the "+" sign on the right to add a new line.
The MBA Program has income eligibility requirements which are based on household size and total household income.
For the following questions, household income refers to any income for the applicant and other members of the household (i.e. spouse/partner, children, relatives) that share financial dependency. Please estimate if needed.
Be prepared to upload paperwork such as W-2s or 1099s, pay stubs, and personal and business bank statements at the end of the application to verify.
If the question does not apply to you please put "0".
Are you or anyone in your household currently employed outside of your business?* Gross salary or wage is any income your household receives from an employer(s) pre-tax. What is your household’s current total monthly gross salary or wage? Do NOT include self employment income.* Are you or anyone in your household currently receiving unemployment compensation?* What is your household’s current monthly unemployment compensation?* Are you or anyone in your household currently receiving general assistance (TANF)?* What is your household’s current monthly general assistance (TANF) income?* If you were certified to receive general assistance (TANF) the last 12 months, you do not need to provide proof of household income (pay stubs, etc..). Rather, if you prefer, you can provide letterhead or some other official document from the organization showing your proof of eligibility or enrollment within the last 12 months.
Are you or anyone in your household currently receiving SSI or SSD (Social Security Benefits)?* What is your household’s current monthly SSI or SSD (Social Security Benefits) income?* Are you or anyone in your household currently receiving child support and/or alimony income?* What is your household's currently monthly child support and/or alimony income?* Are you or anyone in your household currently receiving retirement income from pensions, annuities, 401ks, and/or IRAs?* What is your household’s current monthly retirement (pension/annuities/401ks/IRA) income?* Investment income is income received from dividends or interest from stocks and bonds. Do you or anyone in your household currently receive monthly investment income?* What is your current monthly investment income?* Do you or anyone in your household currently receive income from other sources? This would include things like military benefits, gifts, worker’s comp, rental income, etc.* Please enter the total amount of other monthly income that your household currently receives.* Self-employment Income
This section is for existing businesses that have made past sales. Be prepared to upload a Profit and Loss Statement at the end of the application. The Profit and Loss Statement must, at minimum, show gross sales and business expenses for the two most recent months. How many hours do you currently dedicate to your business on average each week?* Has your business made at least one sale in the past?* When did you make your first sale (estimate)?* The month and year are most important, place a “01” if you do not remember the exact day.
Date Format: MM slash DD slash YYYY
What were the gross sales of your business for the year 2020?* What were the gross sales of your business for the past TWO (2) months?* If you are an existing business, this information is required. If you do not have it ready, please save the application and continue it when have the information on hand.
Business expenses (past 2 months)* What expenses did your business have in the past two months?
This includes (but isn't limited to): cost of goods sold, payroll for employees (not for yourself or members of your household ), overhead (rent, utilities, supplies, etc.), transportation, shipping costs, credit card fees, marketing, etc. Remember to keep your personal expenses separate from your business ones.
Please list each expense and the average monthly amount. Do not itemize each transaction, just bundle expenses into categories, such as "office supplies". If it is an unusual expense (such as yearly licensing fee), please make a note of that under the "Note" section.
Click the "+" sign on the right to add additional expenses.
NOTE: This is required as part of your Profit and Loss Statement. Your application will not be considered unless this information is included. If you do not have this information ready, please save the application and continue it when you have the information available.
What was the business net income for your business for the past 2 (TWO) months?* Gross sales - expenses = business net income.
Be prepared to submit business bank statements for the past two months at the end of the application. If you do not have a business bank account, we will look at your personal bank statements for all members of the household.
Approximately what percentage (%) of your monthly household income currently comes from your business?* Your Business Business Plan/Narrative.
Please fill this section out in detail with complete sentences.
1. Briefly describe your business. What products or services do you or will you sell? If you are just starting out, what sort of research/planning have you already done?*
2. What is your experience with this product or service?*
3. Do you have previous business experience? What type of mentoring, advising, and training do you feel you need to achieve your business goals?*
4. What other resources have you contacted or used for help with your business?*
5. Personal Statement: Please tell us, briefly, about yourself. Why is participation in the Mercy Corps Northwest MBA Program important to you? What challenges have you faced as an entrepreneur (financial, personal, and educational) that you think will be aided by participation?* Please include an explanation of how COVID-19 has impacted your business and any special circumstances to be considered. If you are a prospective business, please explain if/how COVID-19 has influenced you to start a business.
This can be added as a separate document.
Business Information Business type* Indicate which category your business falls under.
All others Arts and Entertainment (gallery, art, ect.) Childcare Food service (restaurant, catering, food truck, ect.) Gym / Fitness Personal services (hair, nails, massage, ect.) Retail Tourism / Hospitality Transportation
In what county is the physical location of your business as listed on your business license? (If your business is in the idea stage, please mark the county your home address is located in).* Is your business currently licensed with the State of Washington (or Oregon)?* Be prepared to upload your business license at the end of the application if your business is currently licensed.
Business name (as listed on your state business license)*
Date licensed with the State of Washington (or Oregon)?* Estimate to the closest month and year. The month and year are most important; place a “01” if you do not remember the exact day.
Date Format: MM slash DD slash YYYY
How many owners or governing people are listed on your business license?* Myself (1) Myself and a spouse or other member of my household (2) Myself and an individual outside of my household (2) Myself and multiple others outside of my household (3+)
Not including yourself, how many full-time paid employees does your business currently employ? Please include any other owners, if applicable.* Full-time is defined as 35+ hours per week.
Include members of your household who are paid for work with your business.
0 (I am the only employee) 1 2 3 4 5 or more
Not including yourself, how many part-time paid employees does your business currently employ? Please include any other owners, if applicable* Part-time is defined as less than 35 hours per week.
Include members of your household who are paid for work with your business.
0 (I am the only employee) 1 2 3 4 5 or more
Business physical address* Please list the physical address of your business as listed on your business license.
Business phone number*
Business email address*
Business website
Business Facebook page
Business Instagram
Business Twitter
Use of Grant Funds The Mercy Corps Northwest Individual Development Account (IDA) matched-savings grant operates on an 8:1 match ratio. This means that for every dollar you save, you will be matched with $8 in grant money. The savings goal for all participants is $500, matched with $4,000 in grant money, for a total of $4,500.
After you meet the program requirements of 1) reaching your savings goal, 2) attending the required educational hours, 3) submitting your business plan for approval, 4) registering your business with the state 5) obtaining an EIN number for your business, and 6) opening a business bank account, you will receive your grant money! Please describe below how you anticipate using your $4,500 to either start or grow your business. (We understand that this may change over time and we will work with you to finalize your purchase list before you receive your grant).
How do you plan on using the money received through this program? Please list specifically how all of the funds will be accounted for. Your answer(s) to these questions should be a brief description of items to be purchased along with the approximate cost of these item(s) and should total at least $4,500.*
Common uses of grant funds include: capital, equipment, machinery, software, professional services, marketing, inventory, and/or general operating expenses for the business.
Grant funds cannot be used for the salary of the business owner/s, the construction or remodeling of a commercial space, or to pay off existing debts.
Click the "+" sign on the right to add additional expenditures.
Household Net Worth Please indicate what your household owns (assets) and what your household owes (liabilities or debts). Your household net worth must be less than $178,900 to qualify for the MBA Program. Household assets and liabilities refers to any asset or liability for the applicant and other members of the household (i.e. spouse/partner, children, relatives) that share financial dependency.
Net worth: Assets
Assets are what your household owns.
Does your household have any cash currently?* How much cash does your household currently have?* Do you or anyone in your household have a personal checking account?* What is the current total amount in your household’s checking account/s?* Please include total amount across all checking accounts.
Do you or anyone in your household have a personal savings account?* What is the current total amount in your household’s savings account/s?* Please include total amount across all savings accounts.
Does your household own at least one vehicle (automobile)?* This includes personal vehicles for which you have an auto loan.
Vehicle values* Please estimate the current values of your vehicles. If you are unsure of the current value of your vehicle, you can use
Kelley Blue Book to get an estimate.
Click the + sign to add another vehicle.
Does your household own a home or other real estate?* Home/Condo 1 Value* If you are not sure of the current value of your home or property, you can use
Zillow.com to get an estimate.
Home/Condo 2 Value* If you are not sure of the current value of your home or property, you can use
Zillow.com to get an estimate.
Home/Condo 3 Value* If you are not sure of the current value of your home or property, you can use
Zillow.com to get an estimate.
Does your household own any Certificates of Deposits (CDs)?* What is the current value of your household's CDs?*
Does your household own any children's savings or children's CDs?* What is the value of your children's savings or children's CDs?*
Does your household own any retirement accounts (pensions, 401k, IRA, etc.)?* What is the value of your household's retirement account/s ( (pensions, 401k, IRA, etc.)?*
Does your household own any non-retirement stocks or bonds?* What is the value of your household's non-retirement stocks or bonds?*
Does your household own any other personal assets?* What is the value of your household's other personal assets?*
Business Assets (own) Do you have a business bank account?* If you have a business bank account, be prepared to upload statements for the 2 most recent months for all business accounts.
What is the current total amount in your business bank account/s?*
Does your business have any assets or inventory?* Value of business assets and inventory.* We are only interested in items (i.e. inventory, machinery, equipment, property) valued at over $1,000 per item. For example, if you are a food business and have food inventory, do not include any individual item (i.e. cheese, milk, flour) that is not valued at over $1,000. If your food business owns a food truck that is valued at over $1,000, you would include that.
Please enter zero if you do not have business assets or inventory whose individual value exceeds that amount.
Click the "+" sign on the right to add additional assets.
Net worth: Liabilities (debts)
Liabilities are what your household owes (debts).
Does your household have any personal vehicle loans?* Vehicle 1 loan balance* Indicate the current balance of the loan.
Vehicle 2 loan balance* Indicate the current balance of the loan.
Vehicle 3 loan balance* Indicate the current balance of the loan.
Does your household own a mortage?* Home/condo/real estate 1 mortgage balance* Indicate the currant balance of your mortgage.
Home/condo/real estate 2 mortgage balance* Indicate the currant balance of mortgage.
Home/condo/real estate 3 mortgage balance* Indicate the currant balance of mortgage.
Does your household have unpaid income or property taxes?* Amount you owe in unpaid income or property taxes?* Does your household have any past due child support payments?* Amount you owe in past due child support payments?* Does your household have any credit card bills?* This includes credit cards, store credit balances, and personal lines of credit.
Credit card balance(s)* Enter "0" in you do not have any credit card balances
Store credit balance(s)* Enter "0" in you do not have any store credit balances
Personal line of credit balance(s)* Enter "0" in you do not have any personal line of credit balances
Does your household have any outstanding medical bills?* Balance of outstanding medical bills* Do you owe money to friends or family members?* Amount you owe to friends or family*
Do you have any student loans?* Balance of outstanding student loans* Do you have any other personal debts?* Total balance of other personal debts* Business Liabilities (debts) Does your business have any debts?* Business debts include loans, etc.
Business debt balances* Include in debts that your business currently owes.
Click the "+" sign on the right to add a new line.
Personal Information
At Mercy Corps Northwest we encourage individuals of all backgrounds to apply for our programs, but particularly welcome people from traditionally underserved populations such as those who identify as women and minorities, domestic violence survivors, immigrants and refugees, 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* Do you identify as Hispanic?* Ethnicity* Asian American Indian/Alaskan Native Black/African American Native Hawaiian/Other Pacific Islander White American Indian/Alaskan Native & White Asian & White Black/African American & White American Indian/Alaskan Native & Black/African American Other/multi-racial Prefer not to say
What is your first or native language?* What is your country of origin (in what country were you born)?* United States Canada Mexico 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 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 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 Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands
Current marital status* Current family situation* Housing Type. Please choose the option that best describes your household’s living situation.* NOTE: Couch surfing, camping, and living in emergency shelters count as homelessness for the purpose of this application.
Have you ever been incarcerated?* All individuals are eligible to apply, regardless of their level of involvement with the justice system.
Are you a military veteran?* Veteran can refer to any applicant who identifies as a veteran from any country.
Do you identify as having a disability?* Do you identify as a survivor of domestic or sexual violence, stalking, or trafficking?* What is the highest level of education you have completed?* Grades K-5 Grades 6-8 Some high school/GED High school graduate- Diploma or GED Some college or technical school, but no degree Technical, trade, or vocational school Associate Degree Bachelor’s Degree Some Graduate School Doctorate/Master’s/Professional degree
Mercy Corps Northwest (MCNW) Services What languages do you feel comfortable communicating and speaking in?* The MCNW staff is bilingual in English and Spanish. This question will assist in knowing what language to use when we send communications to you.
Have you applied to the MBA Program in previous years?* How did you first hear about the MBA Program (check one)?* Please specify the agency or organization that referred you.*
Are you or a family member an employee or volunteer at Mercy Corps Northwest?* Have you or a member of your household participated in an Individual Development Account (IDA) Program or the MBA Program?* If yes, please indicate the name of the family member, use of goal of IDA Program, and matched amount received.* Are you currently using any other services at Mercy Corps Northwest (loans, education services)* What other services at Mercy Corps Northwest are you currently using?*
Are you interested in applying for a business loan through Mercy Corps Northwest’s microenterprise loan program?* Click
here for more information about MCNW's loan program.
Have you ever been registered on the ChexSystems®?* Document Checklist and Upload Your application will be considered incomplete until we receive all required documents. They must be submitted by the application deadline on
February 16, 2021 by
5 pm . If you are mailing them to us, the envelope must be postmarked on or before February 16, 2021.
Please submit copies only, no originals.
If you are unable to upload these documents, email them to
[email protected] or mail them to:
Mercy Corps Northwest
ATTN: Cinthya Montero
1644 Plaza Way #614
Walla Walla, WA 99362
-A copy of your state-issued ID* -Proof of household income (2 most recent months)* Your household must have a source of income that is equal to or greater than the amount you will be saving each month ($84).
Upload paystubs or documents showing gross income for all members of household for the 2 most recent months. Please make sure paystubs cover 2 full months.
If you or other members of your household are paid informally, “under the table”, please include a signed written statement stating hourly rate and average weekly hours worked and how much has been earned for the past 2 months.
Household personal bank statements (2 most recent months)* Upload personal bank statements for the 2 most recent months for both checking and savings accounts for all members of the household that show all transactions.
-2020 Household Income Upload W-2s, 1099s or other forms indicating total income for 2020 for all members of the household. If you have not yet received them, please email copies of them to
[email protected] when you do.
-Personal statement (optional) You can upload any additional information about how COVID-19 has impacted your business or any special circumstances to be considered.
-Business license* Upload a copy of your active business license for the Department of Revenue (Washington) or Secretary of State (Oregon).
Please make sure the physical location address is up-to-date on your license as that is how we will verify that your business is eligible of to be considered for the MBA Program.
Do you have a business checking or savings account for your business?* If you do not have a business bank account and use other platforms such as PayPal for business transactions, please answer "yes" and upload statements for 2 most recent months.
-Business Bank Statements (2 most recent months)* Upload business bank statements for 2 most recent month that show all transactions. Additionally, if you use platforms such as PayPal for business transactions, please upload statements for 2 most recent months.
-Business Profit and Loss (P&L) Statement* Existing businesses must provide a P&L statement. It does not have to be anything fancy. At minimum, it should show gross sales and expenses (examples: cost of goods, payroll for employees, overhead (rent, utilities, supplies), transportation, shipping costs, credit card fees) for the 2 most recent months so we can calculate your business net income (gross sales - expenses = net income).
In the expenses section, you can include payroll for employees but not for yourself (owner's draw) or other members of your household.
Do not include personal expenses.
If available, please include a P&L for the year 2020.
I authorize I have the authority to submit this application on behalf of this business. I agree to work with Mercy Corps to verify any information in my application, should it be requested. By signing below, I certify that all of the information provided in this application is true and complete to the best of my knowledge.* Type full name
By signing my name, I am electronically signing my application and certify this submission of my application.* I understand that any misrepresentation, false or misleading statement may result in the denial of my application or permanent termination from the program.
Signature