COVID-19 Community Assistance Program
Grantee Report Form
Email address *
Date *
MM
/
DD
/
YYYY
Business Name *
Report Prepared by *
Phone Number *
Grant Amount Received *
Please list the amounts and purpose for which the grant funds were utilized. *
Please provide a short narrative of how these funds assisted your business. *
I certify that the funds received for my business were utilized according to the requirements as established in the business application I submitted. *
Required
If you answered "No" above please provide an explanation here.
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