Rural Fast Track Grant Application

State of Utah Governor's Office of Economic Development

Rural Fast Track Grant Application

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Instructions:
Before submitting an application, your local economic development representative must review the project and provide the Governor's Office of Economic Development (GOED) a letter of support with this application that states that the project meets the criteria set forth by GOED and explains how the project promotes business and economic development within the community. A list of county economic development representatives is found here (right click and select 'open in new tab').

For questions related to this form, please contact Linda Gillmor, lgillmor@utah.gov

Each field marked with an asterisk is required.

Company Information

If you submitted a pre-application and received a application ID from us, please enter it here

The application id should be entered in the format: App-xxxx

Company Name

Federal Tax ID

NAICS Code

First Name

Last Name

Title

Address

City

State

ZIP

Work Phone Number

Mobile Number

Email

Current Number of Full-time Employees (excluding contractors/temporary positions)

Years in business

Job Creation Incentive

Jobs must meet the percent-above the current county average wage in order to qualify. A list of county average wages can be found here (right click and select 'open in new tab'). Jobs created prior to the date of a signed contract with the State of Utah are ineligible. Position must be kept in place for at least 12 months before Job Creation incentive funds are disbursed.

Number of projected new FTEs that pay over 110% of the county average annual wage ($1000 per FTE)

Number of projected new FTEs that pay over 115% of the county average annual wage ($1250 per FTE)

Number of projected new FTEs that pay over 125% of the county average annual wage ($1500 per FTE)

Business Development Incentive

Business development incentive can be used for (but not limited to) the purchase of and/or the construction of a new building (or add on to an existing building), equipment, value-added agriculture, leisure & hospitality (certain NAICS codes), etc.

The incentive CANNOT be used for (but not limited to) retail, leisure & hospitality (exceptions for retail and l&h are made in certain eligible counties and depending on NAICS code), non-specialized vehicles, computer/laptops, bare ground etc. Please contact Linda Gillmor with the Office of Rural Development for more information. Lgillmor@utah.gov

Each file upload question below will only accept upto 5MB file size
If you need to upload multiple documents for the same question, please choose the "Upload additional Document" link provided

Detailed description of the project. Include how the project promotes business and economic development and job creation.

Requested Amount (up to $50,000 with company match required)

Please do not enter $ sign

Estimate Total Project Cost

Please do not enter any $ sign

How are you financing this project

BankCashCreditOther

If bank, please specify which bank. If other, please specify.

Please upload quotes, bids, etc.

Estimated number of jobs created (at least one must be a full time position paying at least 110% of county average wage).

Projected wage/salary of highest paying job created.

Business Documents

Local Economic Development Director Support letter. If there is no local Economic Development Director, please obtain a support letter from a local elected official. Please note: Applications will not be reviewed until a support letter is received.

Certificate of Existence from the Utah Division of Corporations

Business license from local municipality

Quarterly DWS unemployment insurance filing (Form 33H)

Company History, description of product/services and target market(s)

Balance Sheet and Profit and Loss statement from last 2 years

Federal and State Returns from last 2 years

IRS Form W-9

This form can be found here (right click and select 'open in new tab').

GRAMA form (Request for confidentiality)

This form can be found here (right click and select 'open in new tab').

SBDC Business Support

Would you like to request free one-on-one management consulting to help with maintaining and growing your business?

YesNo

If yes, please click here (right click and select 'open in new tab'). This will forward you to the SBDC request consulting page .

I hereby certify that all information provided is true and accurate and if anything causes the above not to be true, I will notify the agency. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Type Full name

Submission Date

Format Example: 07/11/2016

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