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Micro-Enterprise Small Business Assistance Program (COVID-19) - Full Application

  1. Micro-Enterprise Small Business Assistance Program - Banner


  3. This application must be filled out, submitted and approved by the program administrator. The Office of Communications, Marketing and Economic Development will review application submittals and provide a determination of eligibility responses to applicants. An oversight review team, consisting of City staff and/or an outside service provider for administrative assistance, will determine eligible applications and make final decisions through a lottery system on whom will be awarded.

  4. Please describe names and titles of current employees (including owner(s)).

  5. Employment Status

  6. Employment Status

  7. Employment Status

  8. Employment Status

  9. Employment Status

  10. Has the business been subjected to criminal or civil fines and penalties including city code violations and regulatory violations and penalties?

  11. If eligible, have you applied for any of the loan Programs from the SBA such as the Economic Injury Disaster Loan, the Payroll Protection Program, or a State of Florida Program such as the Emergency Bridge Loan Program?

  12. Are your property taxes current as of 2018 (paid in full)?

  13. Do you have any outstanding/open code enforcement issues?

  14. Have you paid your 2019 City Business taxes?

  15. Type of Relief Request:

  16. Is your rent/mortgage current?

  17. Contact information for your landlord or property management company:

  18. What is the utility you are requesting payment for?

  19. I/We understand that Title 18, Section 1001 of the U.S. Code makes it a criminal offense to knowingly and willingly make fraudulent statements or misrepresentations of any material fact in the use of or obtaining the use of federal funds. If you knowingly and willingly make fraudulent statements or misrepresentations of any material fact in the use of or obtaining the use of federal funds you may be fined under this title or imprisoned not more than 5 years, or both. Failure to agree will deem your application ineligible.

  20. Please select one of the below. ‘Release’ approves the City to share personal information, ‘Opt-out’ limits sharing information. More details are available in the XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX tab at the top of the webpage.

    RELEASE: I hereby authorize the City of Hollywood to release nonpublic personal information it obtains about me to my creditors and any third parties necessary to provide me with the services I requested. I acknowledge that I have read and understand the above privacy practices and disclosures. OPT-OUT: I request that the City of Hollywood make no disclosures of my non-public personal information to third parties other than those permitted by law. By choosing this option, I understand that the City of Hollywood will NOT be able to answer any questions from my creditors. I understand that I may change my decision any time by contacting the City of Hollywood.


  22. Documents may include year-to-date profit and loss statement through March 31st, the most recent 6 months of bank statements (summary page only), a notice of business closure, or other verifiable method to prove the revenue loss.

  23. The business must provide copies of the submitted applications and documentation as well as the status of these applications (pending/approved/denied).

  24. ** Note that the qualifications are largely based upon federal guidelines related to the use of CDBG-CV funds for this purpose **

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  26. This field is not part of the form submission.