LA South HOPE Foundation Grant Application

Grant Application Form

Business Owners First Name*

Enter business owners first name

Business Owners Last Name*

Enter business owners last name

Business Name*

Enter business name

Business Address*

Enter your Business street address

City*

Enter your city

State*

Enter your state

Zip Code*

Enter your zip code

Business Phone*

Enter your phone number

Cell Phone*

Enter your cell phone number

Email Address*

Enter your email address

Are you a member of LA South Chamber of Commerce?*

How did you hear about the LA South Hope Foundation Grant?

How long has the business been in operation*

Business Formation Type*

Full-Time Employees*

Part-Time Employees

Independent Contractors

Business yearly gross revenue*

What amount of funding are you seeking for your business? *

How will the funds be used? *

Have you considered applying for a small business loan? *

Have you received a small business grant in the past 3 months? *

If yes, from whom?

How much was your Grant Award?

Do You Own Other Businesses*

If so, what is/are the name(s)?

If awarded, would any portion of the Hope Grant be used for the other business(es)? *

If yes, please explain

Please provide a copy of your organizational documentation (i.e., Fictitious Business Name Statement, Articles of Incorporation and/or Articles of Organization) and Business License(s).

Organizational Documentation

Business License

I hereby certify that the information contained herein is accurate and best represents my current business condition. I also understand I will be required to provide a written report to the LA South Hope Foundation (LASHF) by 30 days after receipt, as to how grant funds were used. I will offer testimony to the LA South Chamber of Commerce and LA South Hope Foundation to help support other businesses in the future.*I Agree

Name*

Job Title*