2. APPLICANT INFORMATION

4. Eligible Business*

   1. I have read the eligibility requirements below and am submitting for an eligible business.

   The following are the eligibility requirements for the UpStart Cocoa program:

   	Minority-Owned Business means any small business which is organized to engage in commercial transactions and which is at least 51% owned by minority persons. Persons of minority include African Americans, Hispanic Americans, Asian Americans, Native Americans, and American women.
   	New minority-owned start-up businesses (2 years or less) and any minority-owned business looking to relocate into the City of Cocoa with 10 employees or less.
   	All applicants must be willing to participate in and complete the 24-week business education and mentorship program offered through weVENTURE.
   	Any eating and drinking establishments may be eligible for funding as long as the business derives at least 51% of its gross revenue from the sale of food and/or non-alcoholic drink for consumption on the premises, whether or not the food is cooked on the premises. This may include restaurants, mobile vending, and refreshment stands selling prepared foods for immediate consumption. All applicants who will utilize a mobile vending model will need to commit to required hours/percentage of sales/other in the City of Cocoa area.
   	The types of businesses that are not eligible for funding under this Program include: social service providers, non-profit agencies, gun shops, agricultural services, liquor stores, medical marijuana and CBD shops, shops that sell drug paraphernalia, pawn shops, bailbond services, tattoo/body piercing parlors, check cashing facilities, adult entertainment facilities, thrift shops, nightclubs and bars, and any business or service deemed illegal.
   	The applicant shall not be eligible for the Upstart Cocoa Program if he/she has received Upstart Cocoa Funding, or other business assistance funding from the CRA or the City of Cocoa within the last three (3) years from the date of the current submittal, except for façade improvement programs.
   	For startup businesses, the minority entrepreneur is required to invest at least 10% of startup costs from non-UpStart Cocoa Program related funding sources.

6. I have read, and agree with the Polices, procedures and conditions linked below*

   This document must be read, and agreed to in its entirety, prior to submitting the application. 

   Policies, Procedures and Conditions

   1. I have read, and agree with the Polices, procedures and conditions
8. First Name*
9. Last Name*
11. Personal Address*
13. City*
14. State*
15. Zip Code*
17. Phone Number*
18. Email Address*

22. BUSINESS INFORMATION

24. Business Name*
26. Business Address (this MUST be the address where you plan to open your business in the CITY OF COCOA)*
28. City*
29. State*
30. Zip Code*
32. Website and social media handles for the business
34. Primary Contact*
35. Phone Number*
37. Name of person(s) authorized to sign legal documents*
39. Tell us how you qualify for this loan (gender, racial or minority status)*
41. Desired opening date of business*
43. 1. Describe in detail the nature of your business.*
45. 2. Describe how your business fills a void in Cocoa or complements/supports existing businesses in Cocoa.*
47. 3. Describe what motivates you to start this business.*
49. 4. What do you see as your business’s primary challenges? (Name 3)*
51. 5. What do you see as your primary opportunities? (Name 3)*
53. 6. What experience do you and or partner(s) have that will benefit your business’s success?*
55. 7. If you are awarded funding, explain how it will be used. Please be specific. *
57. 8. How will you repay the City of Cocoa through the Community Enrichment Element? *

    More about Community Enrichment

59. 9. Tell us about your commitment to and understanding of the weVenture Program. *

    More about the weVENTURE program. By signing this application below, you also agree to fully complete the entire 24-week weVENTURE business education and mentorship program in order to complete the UpStart program. If you do not complete the program, you may be required to reimburse the City of Cocoa the cost of the program.

63. ADDITIONAL ATTACHMENTS REQUIRED

65. Business Plan*
66. Budget*
67. Intent to lease or Mortgage showing Ownership*
69. Drawings/Plans
70. Any additional documents

71. Financial statements will be requested separately for applicants that are selected to move on to the Review portion of the process.

75. BUSINESS REFERENCES

    Must list three Professional References

77. Name*
78. Company
80. Address
82. City
83. State
84. Zip Code
86. Phone Number*
87. Relationship
91. Name*
92. Company
94. Address
96. City
97. State
98. Zip Code
100. Phone Number*
101. Relationship
105. Name*
106. Company
108. Address
110. City
111. State
112. Zip Code
114. Phone Number*
115. Relaionship

119. OTHER

121. Other Partners:
122. Percentage of Ownership:

126. DISCLAIMER AND SIGNATURE

128. I certify that my answers are true and complete to the best of my knowledge. If this application leads to an award of the Upstart Cocoa Small Business Program, I understand that false or misleading information in my application or associated documents may result in termination of any funding award and/or program agreement.*

     By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.

129. Date*
     Date
Leave This Blank:


131. 1. Receive an email copy of this form.
132. Email address

     This field is not part of the form submission.

133. Submit Submit and Print

* indicates a required field