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2. REPORTING INSTRUCTIONS
   The City of Nashua provided grants to small businesses under our COVID-19 Impact Fund. Certain businesses received CDBG grants, versus a loan. If you received a grant, you agreed to provide a report at a later date. We will be sharing this information back to the US Department of Housing and Urban Development (HUD). Please use the same names that received the grant. If you have questions, please email Carrie Schena at schenac@nashuanh.gov.
4. Business Name*
6. Owner's First Name
7. Owner's Last Name
9. Business Address
11. Zip Code
13. Email Address*
14. Phone Number
16. Is your business open/operating at this time?*

    1. Yes
    2. No
18. Describe how the grant helped your business. Include as much detail as possible. Such as if you were able to retain jobs (how many); and how you spent the grant funds. This information is required and will be used in federal reports.*
20. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) certify the information provided is true and correct to the best of your knowledge; 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree
22. Electronic Signature*
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit Submit and Print

* indicates a required field