West Side United Grant: 2023 Application

All questions and documentation with an * are required.




If you would prefer the Spanish version of this application, click here.


Si prefiere la versión en español de esta aplicación, presione aquí.

 

Business Background

 

Are you a for-profit business operating on the West Side of Chicago (in Austin, Belmont Cragin, East Garfield Park, Humboldt Park, Lower West Side/Pilsen, Near West Side, North Lawndale, South Lawndale, West Garfield Park, or West Town)?

 

As shown on your income tax return

 

As shown on your income tax return

 

What is the name of your business? (As listed on your tax return)

 
 
 
 

If applicable

 
 
 
 
 

If applicable

 

If applicable

 

If applicable

 

If applicable

 

If applicable

 

If applicable

 
 
 

What type of business location is this?

 
 

To which of the following industries does your business belong?

 
 

Hospital Collaboration

WSU hospitals include: AMITA health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Cook County Health, Rush University Medical Center, Sinai Health System, University of Illinois Hospital & Health Sciences System.

 
 
 
 

Is your business interested in contract opportunities providing goods/services to WSU partner hospitals?

 

Business Owner Background

 

What is the zip code of your home address?

 

What is your email address?

 

What is your phone number?

Phone
 

Demographic Information

Answering the following questions will be used for research purposes only and will not affect your eligibility.

 
 
 
 

What gender do you most identify as?

 

Are you a veteran of the U.S. military?

 

Are you an immigrant?

 

Do you have a disability?

 

Business Financials

 
 

i.e. Do you have a dedicated bank account for your business?

 
 
 
 
 

Required Document Upload

Please upload the documents listed below. All documents are required. All documents should be clear and legible.


  1. Please upload a copy of a government issued photo I.D
  2. Please upload a business bank statement from Q2 2023 (April, May, June)
  3. Please upload your signed 2022 federal business tax return, or signed 2022 federal 1040 individual tax return with schedule C included. (All Pages)
 
Drop your files here
 

Business Opportunities and Challenges

Please answer each question using a maximum of 150 words.

 

What is a goal​​ you want your business to accomplish in the next year?​

(150 words or less)

Note: Goals should be SMART (specific, measurable, achievable, relevant, and time-bound goals associated with numbers, figures and dates, that describes or outline the necessary steps to achieve those goals.)

 
 

How does your business strengthen your community? Please describe how you think your business has improved the neighborhood or area in which it operates. (150 words or less)

 
 

What is your connection to Chicago's West Side? (150 words or less)

 
 

If awarded a $10,000 grant from WSU, for what purpose will you use the grant funding? Be specific about how you would invest these funds. (150 words or less)

 
 

Closing Attestations

 

I attest that all information provided on this application is accurate.

 

I attest that I run a for-profit business that has secured all necessary licenses to operate in Chicago and Illinois.

 

If selected for a grant, I consent to have West Side United promote my business as part of their grant program.

 

If selected, I commit to providing semi-annual reports through calendar year 2024 in which I document the following:

  1. My revenue for the first 12 months of the calendar year
  2. Number of full time or part-time employees for the first 12 months of the calendar year
 

If selected, I commit to providing annual reports through calendar year 2024 in which I document the following:

  1. My revenue for the calendar year
  2. My net income for the calendar year
  3. My year end payroll, including total number of employees, number of staff working full time or part time, number of contractors, number of staff residing in the West Side, and total wages paid
  4. Update on how the funds have been used (first year only) and short written business update
 

I acknowledge that if I fail to meet any of these reporting requirements I will be ineligible for future assistance from West Side United.


 

How did you hear about this opportunity?

 
 
 

By checking this box I attest that all of the information on this application is true. I understand that Allies for Community Business and West Side United do not discriminate against applicants on the basis of race, color, religion, national origin, gender, sexual orientation or identity, marital status, or age (provided that the applicant has the capacity to enter into a binding contract). I authorize Allies for Community Business and its partners at West Side United to investigate and verify the above information. The release of all information by Allies for Community Business and West Side United, in any manner, is hereby authorized whether such information is of record or not and I hereby release all persons, agencies, firms, companies, etc., from any damages resulting from such information.