CARES Act Financial Assistance Application

I am a United States citizen:

Yes
No

I am an enrolled citizen of Tlingit & Haida Indian Tribes of Alaska:

Yes
No

I own 50% or more of the startup business, I am proposing for funding:

Yes
No

I have completed the Spruce Root “Business Basic” or the “SHI Business Basic for Artist” online workshop:

Yes
No

Applicant Name:

Date of Birth:

Social Security No.:

Enrollment Number:

Email:

Home Phone:

Cell Phone:

Alternate Point of Contact (please provide a name and number in the event we cannot reach you):

Physical Address:

Address Line 1:

City:

State:

ZIP Code:

Mailing Address:

Same as Physical Address?

Yes
No

Address Line 1:

City:

State:

ZIP Code:

Business Name:

Business TIN or SSN (this is the tax id you will be reporting your income and expenses to the IRS):

Business Address:

Business City:

Business State:

Business ZIP:

Business Email:

Website:

Industry Type (select one):

Business Type (check one):

Sole Proprietor
Independent Contractor
Partnership
Commercial Fishing
LLC
Eligible Self-Employed Individual
other

If other:

Please upload document to submit