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Application for Small Business Assistance Grants

  1. Background
    Pittsylvania County has been awarded funds from the Virginia Department of Housing & Community Development to aid small businesses in the recovery from COVID-19. Up to a total amount $15,000 for rent/mortgage assistance covering a maximum of 6 months and/or non-construction related retooling is available per small business. A scoring matrix will be used to choose grant recipients. For more information, please contact Susan McCulloch, Project Manager, Pittsylvania County at 434/432-1770. No more than 2 applications may be submitted by any business owner or person; 1 application per business allowed.
  2. Eligible Businesses:
    Eligible Businesses: Assistance through the program will be targeted to businesses that meet each of the following five criteria. 1. Locally or regionally owned and physically located in Pittsylvania County, 2. 20 or fewer employees, 3. Has been impacted by COVID-19, 4. Has not received federal CARES Act assistance for the same purpose and same time period as the SBRAF request, AND 5. Have opened by March 12, 2020.
  3. Application Questions
  4. If you don't know it, you can find your DUNS number at
  5. 7. Is your business located within the Pittsylvania County limits? *
    Only businesses located within the Pittsylvania County limits can receive these grants.
  6. 8. Is this business operated by a Pittsylvania County resident? *
  7. 9. Has your business been in operation in Pittsylvania County on or before March 12, 2020?*
  8. Write n/a if the business does not have a website.
  9. 16. Are you currently open and in operation? *
  10. 17. Have you received federal CARES Act assistance for rent/mortgage or retooling?*
  11. 18. Does the business in the application have less than 20 employees? *
  12. 20. Is your business woman-owned and/or operated? *
  13. 21. Is your business minority-owned and/or operated? *
  14. 22. Type of Business*
  15. 23. Are you Applying for? *
    Remember, Home-based businesses must provide a copy of a business license. Total can't exceed $15,000. Remember, for Home-based businesses A maximum of 25% of the total rent/mortgage may qualify
  16. Remember that the total cannot exceed $15,000.
  17. Remember that the total cannot exceed $15,000
  18. Remember that the total cannot exceed $15,000.
  19. If retooling and technology is requested, please describe what needs your business has related to the business response to COVID-19. If not, please write n/a.
  20. 27. Employee or client information?*
    Would you be willing to provide information regarding your clients or employees for reporting purposes?
  21. Required Attachments
    Each of these documents must be included to be considered for the grant program.
  22. Please attach your W-9 for 2020 or most recent year.
  23. This statement should run from January 1, 2019 to the present.
  24. If you are requesting mortgage or rent relief then the following documentation is required.
  25. Submit a photo of your signature. This is required for your application to be considered.
    WARNING: Section 1001 of Title 18 of the United States Code makes it a criminal offense to make a willfully false statement or misrepresentation to any Department or Agency of the United States as to any matter within its jurisdiction. Verification of any or all information contained in this application may be obtained from any source named herein. By submitting this form you are agreeing that the information contained in this application is accurate and complete to the best of my knowledge. I hereby grant permission to project staff to verify any or all information contained in this application or any additional information that I may provide in support of this application. I understand that the information in this application will be held in strict confidence as required under the provisions of the Virginia Privacy Protection Act, and will only be used to determine my eligibility for business assistance under this project.
  27. Leave This Blank:

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