Take It Outside-Small Business Application
To be eligible to receive support from an Intermediary under the Take it Outside (TIO) program, a small business must meet certain eligibility criteria. This application allows the Take It Outside team to vet applicants as well as track the supports given to businesses.
Applicant Email
example@example.com
Legal Business Name (Please provide the exact legal business name (e.g., Main Street Business, LLC), as listed on your Secretary of State filing, or tax filing. If your business is not incorporated (e.g., you file a Schedule C with your personal tax return), please list your legal first and last name here.)
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If applicable, business DBA ("Doing Business As")
Applicant Name
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First Name
Last Name
Phone Number
Please enter a valid phone number.
How would you like us to communicate with you regarding your request
Phone
Email
Text
Other
If you chose "Other," please specify:
Physical Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Taxpayer Identification Number
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Is your business in or considering federal bankruptcy or state receivership? "Yes” means that your business is in or considering federal bankruptcy or state receivership. “No” means that your business is not in or considering federal bankruptcy or state receivership.
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Yes
No
Is the business permanently closed? If you are taking actions necessary for running your business and generating business income, your business would not be considered permanently closed. Seasonal businesses should answer “No” even if they are not yet open for the 2022 season.
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Yes
No
Is your business at least 51% owned by women and/or minorities ( A small business concern which is at least fifty-one percent (51%) owned and controlled by one or more socially and economically disadvantaged individuals or in the case of a publicly owned business, at least fifty-one (51%) of the stock of which is owned by one or more socially and economically disadvantaged individuals; and whose management and daily business operations are controlled by one or more such individuals. "Socially and economically disadvantaged individuals" are individuals who are citizens or lawful permanent residents of the United States the following groups are presumed to be both socially and economically disadvantaged: Members of a definable minority group means a person who is a citizen or lawful permanent resident of the United States and who is listed below)?
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Yes
No
If you answered yes, please check the following box(es) to indicate ownership descriptions:
Women(Women (Any female qualifies as a class of minority.)
Black (All persons having origins in any of the Black racial groups of Africa.)
Hispanic (All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.)
Portuguese (All persons of Portuguese, Brazilian or other Portuguese culture or origin regardless of race.)
Asian All persons having origins in any of the original peoples of the Far East, Southeast, Southeast Asia, the Indian Subcontinent, or the Pacific Islands.)
American Indian/Native Amecican All persons having origins in any of the original peoples of North America.)
Eskimo/Aleut
Economically and Socially Disadvantaged Members of other groups or other individuals, found to be economically and socially disadvantaged by the small Business Administration under Section 8 (a) of the Small business Act, as amended 15 U.S.C. Chapter 637 (a)).)
Not Disclosing
Have you received funding from an additional intermediary under this Take It Outside program?
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Yes
No
If yes, please specify which
Please explain how your business has been negatively impacted by COVID-19? (Note: This is a requirement for receiving support through the Take It Outside program.)
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Being forced to close or curtail business operations due to the pandemic or a government order pertaining to the pandemic
Experiencing a supply chain delay or disruption that negatively impacted operations
Experiencing increased cost as a result of the pandemic
Being forced to lay off workers as a result of the pandemic
Other
If you chose "Other," please specify:
Did your business earn less than $1 million in gross revenue in either 2020 or 2021? Please choose the revenue range that most closely reflects your gross revenue (Note: This is a requirement for receiving support through the Take It Outside program.)
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$0-$50,000
$50,001-$100,000
$100,001-$250,000
$250,001-$500,000
$500,000-$999,999
$1,000,000 or greater
Do you attest to your establishment being not disbarred from SAM.gov? (Note: This is a requirement for receiving in-kind or programmatic support through the Take It Outside program.)
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Yes
No
Will this support assist your business with expanding your outdoor capacity?
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Yes
No
Will this support assist your business with expanding business operations?
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Yes
No
Signature
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Date
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-
Month
-
Day
Year
Date
Please verify that you are human
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Submit
Should be Empty: