Business Nonprofit Application | The Oregon Cares fund

Eligibility and Required Documentation

Proof of eligibility must include:
- Description of COVID-19 pandemic impact on organization. Narrative description of impact on the organization of COVID-19 pandemic related closures, restrictions, interruptions, or required business model shifts resulting in lost revenue or COVID-19 related increased costs.
- P&L Reports: The following profit and loss reports (P&L reports):
- COVID-related expenses: Organizations to additionally submit:
- Current IRS W-9 Form
All businesses and non-profits will be required to show evidence of active business registration in Oregon.

By clicking the checkbox below, I agree that I have read the above and understand that I will need to provide proof of financial hardship due to COVID-19 and have documents or clear images ready to upload at this time in order to complete the application.
Consent*
I agree*

Who will be the primary contact for this application?*
- Myself (Owner/CEO)
- Someone else

Primary contact information
Name*
First Last
Email*
Enter Email Confirm Email
Phone*

Owner/CEO information
Name*
First Last
Email*
Enter Email Confirm Email
Mobile phone

Business details
Name of organization*

(As registered with the Oregon Secretary of State)
Business registration number*

Your business registration number must be active.

To find your existing business registration number online, you can search the registry. If you need to renew or register for the first time, you can do so here.

For additional assistance, visit this page.
Taxpayer identification number (EIN)*

If you are a sole proprietor and do not have an EIN, you may enter your SSN here.

W-9 Upload
Max. file size: 256 MB.

Business address*
Street Address City State ZIP Code

If you have multiple locations, please provide information for your main office/location.
Business phone number*
Business website

Current number of employees*
Please enter a number from 0 to 10000.
If your business is a sole proprietorship, please enter "0".

What's a sole proprietorship?

Business type*
- Nonprofit
- For-profit

What percentage of owners of this business identify as Black?*
Please enter a number from 0 to 100.
What percentage of the executive team members identify as Black?*
Please enter a number from 0 to 100.
What percentage of the members of the Board of Directors identify as Black?*
Please enter a number from 0 to 100.

Description of COVID-19 pandemic impact on organization
Please describe the impact of COVID-19 on your business.*
Include details about closures, restrictions, interruptions, or required business model shifts resulting in lost revenue or COVID-19 related increased costs.

Profit and Loss (P&L) reports

Two reports are required:
- Pre-COVID-19 Period: 1/1/2020—2/29/2020
- COVID-19 Period: 3/1/2020—most recent month*
If you do not have an existing P&L report, you may download this simple P&L Report template to upload and submit with your organization's application.

If you create your P&L report using accounting software such as Quickbooks, please upload your documents in PDF format.

*Your "most recent month" is the last full month that has passed as of the date of your application. For example, if you are applying in mid-August, your most recent month would be July.
Please upload your P&L reports below*
Drop files here or

Accepted file types: jpg, gif, png, jpeg, bmp, pdf, raw, tiff, heic, xls, xml, csv, xlsx, xlm, xla, Max. file size: 256 MB.
Note: You can upload your IRS Form W-9 here as well, per application requirements.

In addition to your uploaded P&L reports for 2020, we need revenue and expense amounts for the 2019 fiscal year.

This information will help us calculate your financial need.
Total Revenue (2019)*
Revenue is the total amount of income generated by the sale of goods or services related to the business or nonprofit's primary operations.
Total Expenses (2019)*
Your total amount may include: wages, benefits, operating expenses, cost of goods sold, etc.

*IMPORTANT*
For verification purposes, all amounts inputted over the next few sections must match the reported amounts on your uploaded P&L documents.

This information will help us calculate your financial need.

P&L Details - Pre-COVID-19 Period

Profits and losses for January through February of this year.
Total Revenue (January and February 2020)*
Total Expenses (January and February 2020)*

P&L Details - COVID-19 Period

Profits and losses for March 2020 through month-ended prior to application.
What was the most recent month, as of the date of this application?*
For example, if you are applying in August, your most recent month would be July.
Total Revenue (March 2020 up to the most recent month)*
Total Expenses (March 2020 up to the most recent month)*

Simple budget of additional expenses related to COVID-19

Businesses and nonprofits must articulate any unforeseen, unplanned expenses due to the COVID-19 pandemic. Simple budgets must include any incurred expenses along with projected COVID-19 related expenses for the remainder of 2020.

Please download and complete this Simple Budget template.

Examples of additional expenses include: purchasing PPE, cleaning/disinfecting costs, hiring additional staff as a result of COVID-19 and social distancing requirements, or other miscellaneous expenses caused by COVID-19.
Upload your completed Simple Budget template below.*
Drop files here or

Accepted file types: jpg, gif, png, jpeg, bmp, pdf, raw, tiff, heic, xls, xml, csv, xlsx, xlm, xla, Max. file size: 256 MB.
Note: You can upload your IRS Form W-9 here as well, per application requirements.

Additional expenses related to COVID-19 (Details)

If you did not have COVID-19 related expenses for any of the following fields, please enter "0".
Amount spent on PPE so far in 2020*
Personal protective equipment (PPE) includes protective clothing, gowns, gloves, face shields, goggles, face masks, and respirators or other equipment designed to protect the wearer from injury or the spread of infection or illness.
Projected PPE expenses for remainder of 2020*
Cleaning/disinfecting expenses so far in 2020*
Please enter a number from 0 to 1000000.
Projected cleaning/disinfecting expenses for remainder of 2020*
Please enter a number from 0 to 1000000.
Amount spent on hiring of additional permanent or temporary staff for COVID-19 & social distancing requirements*
Please enter a number from 0 to 1000000.
Projected hiring expenses for remainder of 2020*
Please enter a number from 0 to 1000000.
Payroll & benefit costs not covered by revenues (so far in 2020)*
Please enter a number from 0 to 1000000.
Projected payroll & benefit costs not covered by revenues for remainder of 2020*
Please enter a number from 0 to 1000000.
Other COVID-19 related expenses (so far in 2020)*
Please enter a number from 0 to 1000000.
Other COVID-19 related expenses projected for remainder of 2020*
Please enter a number from 0 to 1000000.

Attestation

I hereby attest to the following:

(a) to the best of my knowledge, the information provided in this application for an Oregon Cares Fund grant, including all supporting documentation, is true and accurate;

(b) I am the person most knowledgeable in the applicant organization regarding information provided in this application or I have verified the information with those persons who are most knowledgeable in the applicant organization regarding the truth and accuracy of the information;

‎(c) the applicant organization is in need of emergency financial assistance to mitigate the impact of the COVID-19 pandemic, as described in this application;
‎
(d) I understand that it is a requirement to, and the organization will, use any grant funds received to pay for the applicant organization’s reasonable, necessary, and essential ‎organizational expenses or emergency financial needs arising due to the COVID-19 ‎pandemic and incurred between March 1, 2020 and December 30, 2020, provided that, if grant funds are not used for these purposes, the funds will be returned to the ‎grantor of the funds;

(e) neither the applicant organization, nor any other entity that is consolidated in the financial statements of the applicant organization, has filed any other application for assistance from the Oregon Cares Fund;

‎(f) grant funds received will not be used for expenses otherwise ‎paid for by ‎insurance, reimbursements, or other financial assistance programs;‎ and
‎(g) I certify that I am eighteen (18) years of age or older; and

(h) I have full power and authority to submit this application on behalf of the applicant organization.

By submitting this application, I acknowledge that the information provided in this application may be subject to audit, which could result in an obligation to return the grant funds if the information provided is not correct or the statements made in this attestation are false. I certify that this application is complete and accurate, I agree to the conditions of this application, and make this attestation subject to penalty for perjury.
Attestation I hereby attest to the following: (a) to the best of my knowledge, the information provided in this application for an Oregon Cares Fund grant, including all supporting documentation, is true and accurate; (b) I am the person most knowledgeable in the applicant organization regarding information provided in this application or I have verified the information with those persons who are most knowledgeable in the applicant organization regarding the truth and accuracy of the information; ‎(c) the applicant organization is in need of emergency financial assistance to mitigate the impact of the COVID-19 pandemic, as described in this application; ‎ (d) I understand that it is a requirement to, and the organization will, use any grant funds received to pay for the applicant organization’s reasonable, necessary, and essential ‎organizational expenses or emergency financial needs arising due to the COVID-19 ‎pandemic and incurred between March 1, 2020 and December 30, 2020, provided that, if grant funds are not used for these purposes, the funds will be returned to the ‎grantor of the funds; (e) neither the applicant organization, nor any other entity that is consolidated in the financial statements of the applicant organization, has filed any other application for assistance from the Oregon Cares Fund; ‎(f) grant funds received will not be used for expenses otherwise ‎paid for by ‎insurance, reimbursements, or other financial assistance programs;‎ and ‎(g) I certify that I am eighteen (18) years of age or older; and (h) I have full power and authority to submit this application on behalf of the applicant organization. By submitting this application, I acknowledge that the information provided in this application may be subject to audit, which could result in an obligation to return the grant funds if the information provided is not correct or the statements made in this attestation are false. I certify that this application is complete and accurate, I agree to the conditions of this application, and make this attestation subject to penalty for perjury.*
I agree.*

Oregon Cares Business and Nonprofit Application

Step 1 of 19

Eligibility and Required Documentation

Primary contact information

Owner/CEO information

Business details

Description of COVID-19 pandemic impact on organization

Profit and Loss (P&L) reports

IMPORTANT

P&L Details - Pre-COVID-19 Period

P&L Details - COVID-19 Period

Simple budget of additional expenses related to COVID-19

Additional expenses related to COVID-19 (Details)

Attestation

Oregon Cares Business and Nonprofit Application

Step 1 of 19

Eligibility and Required Documentation

Primary contact information

Owner/CEO information

Business details

Description of COVID-19 pandemic impact on organization

Profit and Loss (P&L) reports

*IMPORTANT*

P&L Details - Pre-COVID-19 Period

P&L Details - COVID-19 Period

Simple budget of additional expenses related to COVID-19

Additional expenses related to COVID-19 (Details)

Attestation

IMPORTANT