TIME Program Application
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This field is required, choose the type of funding you're requesting.
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This field is required, include the applicant's full name.
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This field is required, include the applicant's address.
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This field is required, include the applicant's email address.
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This field is required, include the applicant's phone number.
Section I, Business Information:
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This field is required, include the name of the business.
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This field is required, include the address of the business.
Business Owner #1 Information:
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This field is required, include Owner #1's full name.
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This field is required, include Owner #1's ownership percentage of the business.
Round to the nearest whole number from 1 to 100.
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Business Owner #2 Information:
Additional Business Owners:
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This field is required, include the date the business was established.
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This field is required, include the tax identification number of the business.
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Forms of Operation:
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Violates any U.S. federal or state law.
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Owned/controlled by any government agency, public administration, political organization, or non-profit of any type, including labor groups.
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Are engaged in any illegal activity (other than routine traffic violations);
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Are primarily in the business of manufacturing, promoting or selling diet aids, cannabis, gambling, tobacco (including tobacco-related equipment, such as e-cigarettes), firearms or other weapons.
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Are private clubs and businesses which limit the number of memberships for reasons other than capacity or related to applicable U.S. federal or state health guidelines;
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Are principally engaged in teaching, instructing, counseling or indoctrinating religion or religious beliefs, whether in a religious or secular setting.
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Derive directly or indirectly more than de minimis gross revenue through the sale of products or services, or the presentation of any depictions or displays, of a sexual nature.
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Are fraternities, sororities or alumni groups;
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Are owned by employees, officers and directors of the Columbus Area Chamber of Commerce Foundation, Inc or the NAACP Columbus/Bartholomew Branch 3071 and any affiliated entities, and their respective immediate families (parents, spouse, children, siblings) or individuals residing in their household (whether or not related);
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Are listed on the U.S. Department of the Treasury’s Sanctions List.
Section II, Financing Information and Use of Funds:
Funds from this program may only be used for specific expenditures and in certain situations. Please review allowable uses below:
Allowable expenses from Funding
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Rent, Operating capital for leasing space
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Cost of Goods Sold (food cost, materials)
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Marketing materials and advertising including website development and servicing
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Licenses, dues, subscriptions
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Phone and Internet
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Supplies
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Insurance and/or utilities
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Staff salaries
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Equipment Leases and Software Payments, Equipment purchase (with or without installation costs)
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Purchasing inventory, supplies, accounting and inventory software, furniture, fixtures, and equipment
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Professional services including legal, financial, business consulting services,
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Costs of design and retrofitting businesses to accommodate social distancing, including developing Covid-19 related policies
Ineligible use of Funding
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Pay off non-business debt, such as personal credit cards for purchases not associated with the business
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Purchase personal expenses such as buying a new family car or making repairs to a participant's home
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Purchase personal items, or support other businesses in which the borrower may have an interest
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Distribute funds to a director or entity owned/controlled by a director
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Programs designed to influence - or fund through political contributions - a particular law, election or politically-oriented cause, including voter registration and organized labor organizations and programs;
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Any program that results in direct financial benefit to a specific individual, or an individual sponsorship related to fundraising activities;
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Religious programs or sectarian programs for religious purposes;
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This field is required, include the amount of funding being requested.
Round to the nearest whole number. A dollar sign is not required.
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This field is required, include a description of how you plan to use the funding.
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If yes, what is/are your potential source(s) of repayment:
Section III, Legal and Other Topics:
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Section IV, Other Supporting Information:
Section V, Certifications:
Please read the following and sign the Application Form below.
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The information in this application is provided for the purpose of applying for funds under the TIME Program.
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The information is accurate to the best of my knowledge and I understand if I falsify any information it may make me ineligible for future support extended by programs of NAACP Columbus/Bartholomew Branch 3071.
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I understand that personal and/or business financial and credit information may be requested pursuant to this funding application, and I hereby give my consent for such information to be provided to the NAACP Columbus/Bartholomew Branch 3071, First Financial Bank, and/or Columbus Area Chamber of Commerce, or Columbus Area Chamber of Commerce Foundation representatives.
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I understand that the TIME program retains the sole discretion as to whether this funding application is approved, disapproved, or modified.
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I understand that it is my right to accept or decline the funding amount, rate and terms approved through the program.
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I have included a complete, signed W9 form with this application.
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This field is required, include the printed name of the applicant who signs below.
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This field is required, include the digital signature of the applicant.
This field is required, include the date this application was signed.
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