Survey : Questions

The Emporia Community Foundation, Emporia Main Street, KVOE, and United Way of the Flint Hills are pleased to announce the creation of the Greater Emporia Area Disaster Relief Fund. The four agencies joined forces to broaden the reach of the existing Lyon County Disaster Relief Fund in order to support the needs of businesses, nonprofits, and individuals in Chase, Coffey, Greenwood, Lyon, Morris, Osage, Wabaunsee, and Woodson counties surrounding COVID-19 relief. 100% of donations will be used to help respond to COVID-19 in the region. The Emporia Community Foundation, where the funds will be held, is waiving administrative fees for the fund.

The Business Jump Start Grant will provide small locally owned businesses with small grants for the purpose of building inventory and service capacity as business restrictions surrounding the pandemic are relaxed or eliminated. We want to ensure that businesses are in a position to jump start sales as the community regional business environment emerges from the worst impacts of the Covid-19 pandemic.

The Greater Emporia Area Disaster Relief Fund will have multiple phases of funding to address both the immediate and longer-term needs related to this crisis. The initial focus is on the medical community. Future phases will focus on economic needs. Priority will be given to local organizations working to meet the basic needs of those most significantly impacted by this crisis.

Those interested in donating to the fund may give online at emporiacf.org/make-donation, unitedwayoftheflinthills.org, or emporiamainstreet.com. Donors may also mail their contribution to either the United Way or the Emporia Community Foundation. Until the statewide stay-home order is lifted, both United Way and Emporia Community Foundation offices are closed to the public, so donors are asked not to make donations in person.

For more information, please contact:

United Way of the Flint Hills: Mickey Edwards, (620) 342-7564 or mickey@uwfh.org KVOE: Ron Thomas, (620) 342-1400 or thomasr@kvoe.com

Emporia Main Street: Casey Woods, (620) 340-6430 or main.street@emporia-kansas.gov Emporia Community Foundation: Becky Nurnberg, (620) 342-9304 or becky.nurnberg@emporiacf.org

Eligibility for the greater Emporia Area Disaster Relief Fund Jump Start Grant is as follows:

- Must be an existing locally owned for-profit business within the defined region.

- Must have 100 or fewer employees owned and operated within the defined region.

- Eligible business categories include: retailers, restaurants, bars, service based businesses, and event centers.

- Eligible business entities include: LLC's, Sole Proprietors, S-Corps, C-Corps, and Limited Partnerships.

- Funding can be used for working capital expenses that include but are not limited to inventory and other assorted startup costs for existing businesses reopening or expanding operations as pandemic restrictions relax.

- Eligible businesses must operate from a commercially zoned property which they own or are the primary lessee.

- Eligible businesses must have a separate business checking account. We will not write grant checks to a personal checking account.

- Grant funds are not intended to replace past lost income or satisfy past debts. Grant allocations are specifically targeted for inventory or operational expenses for businesses preparing for reopening, transitioning business operations in compliance with health related statutes, or pivoting business activities to prepare for emerging customer wants/needs.

1.	What is your official business name?
	50 characters left.

2.	What is your Tax I.D. or EIN #?
	50 characters left.

3.	What was the Month and Year your business was established?
	50 characters left.

4.

What is your Business Entity type?

LLC

Sole Proprietorship

S-Corp

C-Corp

Limited Partnership

Other

Comment:
500 characters left.

5.

Does the applying business have a related operating or holding company?

Yes

No

6.	If you answered yes, please provide the name of the related entity:
	50 characters left.

7.

Does your business operate from a commercially zoned property that you own or serve as the primary lessee?

Yes

No

Comment:
500 characters left.

8.

Does your business have a dedicated business checking account? (The Greater Emporia Area Disaster Relief Fund will not write grant allocation checks to a personal checking account).

Yes

No

Comment:
500 characters left.

9.

Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:	emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province (US/Canada):
Postal Code:

10.

Has your business applied for and/or received Covid-19 relief funding from any other sources?

Yes

No

Comment:
500 characters left.

11.	If you answered yes, please list all the sources your business applied for and/or received for Covid-19 relief funding. The Greater Emporia Area Disaster Relief Fund encourages businesses to seek additional funding from a variety of sources. A lack of additional funding acquisition or attempt may result in a lower score for your business grant application.
	1000 characters left.

12.	If you receive a grant, how would your business utilize funds to help restart or expand your business once pandemic regulations are relaxed?
	1000 characters left.

13.	Please provide an overall description of the business and relevant details (business name, length of time in business, services provided, products produced, business's mission and goals, etc.):
	1000 characters left.

14.	Describe how the use of The Greater Emporia Disaster Relief Fund enhances the ability of this business to survive:
	1000 characters left.

15.	What is the current number of full time employees for the business?
	50 characters left.

16.	What is the current number of part time employees for the business?
	50 characters left.

17.	How does your business contribute to the community and/or region outside of normal business operations? (i.e. What are the specific local causes, groups, or activities your business supports?)
	1000 characters left.

18.	What is the dollar amount of your funding request? (these are small grants, with totals awarded decided on a case by case basis) IF YOU DO NOT REQUEST A DOLLAR AMOUNT, THE GREATER EMPORIA AREA DISASTER RELIEF FUND CANNOT FUND YOUR ALLOCATION REQUEST.
	50 characters left.

The applying business certifies that the information entered into this Application is true and accurate to the best of their knowledge. By applying for this fund, the applicant agrees to the marketing release below.

Marketing Release of Information Declaration

The recipient of a Greater Emporia Area Disaster Relief Fund Jump Start Grant, hereafter referred to as "Client", agrees to the following Marketing Release of Information to be used by the Emporia Main Street for the purpose of promoting the successful delivery of services to entrepreneurs and small business owners.

The Client agrees to provide pertinent information to Emporia Main Street for the purpose of preparing a news release for distribution to other Resource Partners and media outlets as determined by Emporia Main Street; Information for the news release will be obtained primarily from the application, corresponding documents, the Resource Partner and the Client's web sites and previously published information, and by phone interviews with representatives of both parties;

In addition to disseminating the resulting news release to media outlets, Emporia Main Street may distribute all or part of the news release and related information to organizations, networks, and individuals via email, Emporia Main Street and third-party Web sites, blogs, instant messaging, chat rooms, message boards, etc.