2. The following is a prescreening questionnaire for the Microenterprise Grant Program.  This questionnaire does not constitute an application for the program, however, it is the first step in determining applicants' eligibility to receive funding.

   After the prescreen questionnaire has been submitted we will be in touch to discuss next steps.  Any additional questions or concerns about this questionnaire contact the office of DCED at dced@hagerstownmd.org or 301-739-8577 ext. 111.

   (Please note all answers to the below questions will be kept confidential.)

4. Business Name*
6. Business Address*

   Please note only business located in the City of Hagerstown or who do two-thirds of their business in the City of Hagerstown are eligible for funding.

8. Owner's Name*
10. Owner's Email Address*
12. Owner's Phone Number*
14. Month/Year Business Established *
16. Description of Business*
18. Applicants are asked to answer the following questions to determine if the applying business meets the eligibility criteria for the grant program.
20. Does your business have five or fewer employees? (This number must include the owner(s) and is reflective of total headcount)*

    1. Yes
    2. No
22. 
24. The applying business must be located in the corporate boundaries of the City of Hagerstown. Please select yes if your business is located in the City of Hagerstown.*

    1. Yes
    2. No
26. The applying business' owner(s) must have an income that is either at or below the above income levels based on the number of persons residing in their household. Please select yes if the business owner's household has an income that is either at or below these levels and no if the business owner's income exceeds these listed amounts.*

    1. Yes
    2. No
28. Grant awards are only provided to businesses that have already identified projects/service/products/etc. to spend grant funds on if awarded- has your business identified how the funding will be spent?*

    1. Yes
    2. No
30. If your business has been operating for less than twelve (12) months will you be able to provide a copy of a business plan with your application?*

    1. Yes
    2. No
32. How did you hear about this program?
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field