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Assistive Technology (AT) Small Business Grant for Visually Impaired owned Companies
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First Name
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Last Name
Your answer
Email Address
Your answer
Phone Number
Your answer
Address 1
Your answer
Address 2
Your answer
City
Your answer
State
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Zip Code
Your answer
Name of Business
Your answer
Is the owner of your company legally blind?
Yes
No
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Is your company a for-profit or a non-profit business?
For-Profit Business
Non-Profit Business
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Business Type
LLC
C Corporation
S Corporation
Non-Profit
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Number of Company Employees
Your answer
Years in Operation
Your answer
How does your AT Product help the Visually Impaired?
Your answer
Total annual sales (include both volume and revenue) of your AT Product
Your answer
Is your AT Product manufactured by visually impaired individuals?
Yes
No
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Is your AT Product manufactured in the United States of America?
Yes
No
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Total Grant Amount Requested
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Expected Outcomes if You Receive The Grant
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Detailed Budget Breakdown ( materials, labor, marketing)
Your answer
Measurement of Success (How will you measure the impact?)
Your answer
Sustainability Plan (How will you grow after the grant period?)
Your answer
Do you have other funding sources (who and how much)?
Your answer
Pitch deck video link
Your answer
Proof of Legal Blindness (A letter from your doctor)
Option 1
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Letters of Recommendation (optional)
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