Grant Application Form

Name *

First Name

Last Name

Birthdate

MM

DD

YYYY

Phone

(###)

###

####

Do you have a disability?

Yes

No

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Check One

New Project

Existing Project

Expansion

Check One

Incorporated

Proprietorship

Partnership

Check One

Full Time

Part Time

Seasonal

Do you or will you own 51% of the business?

Yes

No

Will your business employ others?

Yes

No

Grant Program you are applying for:

Micro Business Grant - $2,500

Mini Business Grant - $5,000

Small Business Grant - $10,000

Have you included everthing?

application complete

quotes are attached

current resume attached

information given in the application and accompanying attachments is complete and correct

I am a registered member of Gingolx, and have included a copy of my Nisga'a Citizenship card

ACKNOWLEDGEMENT

I hereby certify that the information provided is complete and accurate to the best of my knowledge and I hereby give Gingolx Village Government permission to make necessary inquiries concerning this application. This formation is considered to be confidential.

Applicant's Name

First Name

Last Name