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SSBCI Technical Assistance Inquiry for Companies
Are you applying / do you plan to apply / have you applied for an SSBCI capital program or other federal or jurisdiction small business program? (Please note, this is a criteria requirement.)
(Required)
Yes
No
Were you referred to this program by a Connecticut Innovations Team Member?
(Required)
Yes
No
If yes, please provide the name of the person
General Company Information
Legal Company Name
(Required)
Company Address
(Required)
Contact Name
(Required)
Email Address
(Required)
Phone Number
(Required)
Federal ID#
(Required)
Do not enter dash
Connecticut State Tax ID#
(Required)
NAICS Code
(Required)
Type of Entity (LLC, C-Corp, Inc., etc.):
(Required)
Date Incorporated
MM slash DD slash YYYY
Where is the company incorporated?
If not incorporated, type N/A.
If the business is not incorporated, please state its legal structure.
Please upload your company pitch deck.
(Required)
Drop files here or
Select files
Max. file size: 50 MB.
Grant Information
Type of Grant Requested
(Required)
Choose one
Legal
Accounting
Financial Services
Amount Requested
(Required)
Please briefly describe the services you are requesting.
(Required)
Company Ownership/Employees
Does the company meet any of the following SEDI Criteria?
YES
NO
IF YES, Please select all of the following SEDI criteria requirements that your company meets.
Business enterprise that certifies that it is owned and controlled by individuals who have had their access to credit on reasonable terms diminished compared to others in comparable economic circumstances. (A)
Business enterprise that certifies that it is owned and controlled by individuals whose residences are in Community Development Financial Institution (CDFI) Investment Areas. (B)
Business enterprise that certifies that it will build, open or operate a location in a CDFI Investment Area. (C)
Business enterprise that certifies that it is located in a CDFI Investment Area. (D)
Full SEDI definitions can be found at the bottom of this page.
Full-Time Equivalent Employees (FTEs)
(Required)
The number of employees rounded to the nearest whole number, at the time TA services are provided. This is determined by adding the number of full-time employees and the number of part-time and seasonal employees as a fraction of a full-time employee. For example, if a business has 100 employees working full-time (assume a full-time week of 40 hours) and 50 employees working 20 hours per week, the total number of FTEs would be 125. For seasonal employees, the FTE count is based on a 2,080-hour year, so that an employee who works 520 hours per year counts as 0.25 FTEs. Volunteers (i.e., individuals who receive no compensation, including no in-kind compensation, for work performed) are not considered employees.
Additional Information regarding SEDI owned businesses
Socially and Economically Disadvantaged Individual (SEDI)-owned business. A: a business enterprise that certifies that it is owned and controlled by individuals who have had their access to credit on reasonable terms diminished compared to others in comparable economic circumstances, due to (1) membership of a group that has been subjected to racial or ethnic prejudice or cultural bias within American society, (2) gender, (3) veteran status, (4) limited English proficiency, (5) disability, (6) long-term residence in an environment isolated from the mainstream of American society, (7) membership of a federally or state-recognized Indian Tribe, (8) long-term residence in a rural community, (9) residence in a U.S. territory, (10) residence in a community undergoing economic transitions (including communities impacted by the shift toward a net-zero economy or deindustrialization) or (11) membership of an underserved community (see Executive Order 13985, under which “underserved communities” are populations sharing a particular characteristic, as well as geographic communities, that have been systematically denied a full opportunity to participate in aspects of economic, social and civic life, as exemplified by the list in the definition of “equity.” Equity is consistent and systematic fair, just and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality; B: a business enterprise that certifies that it is owned and controlled by individuals whose residences are in Community Development Financial Institution (CDFI) Investment Areas, as defined in 12 C.F.R. § 1805.201(b)(3)(ii);3 C: a business enterprise that certifies that it will build, open or operate a location in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii); or D: a business enterprise that certifies that it is located in a CDFI Investment Area, as defined in 12 C.F.R. § 1805.201(b)(3)(ii). For purposes of the definition of “SEDI-owned business,” a business is “owned and controlled” by applicable individuals: (1) if privately owned, 51 percent or more is owned by such individuals; (2) if publicly owned, 51 percent more or of the stock is owned by such individuals; and (3) in the case of a mutual institution, if a majority of the board of directors, account holders and the community that the institution services is predominantly composed of such individuals.
Consent
(Required)
I agree
ANY FALSE STATEMENT MADE HEREIN IS PUNISHABLE AS A CLASS A MISDEMEANOR UNDER SECTION 53a-157b OF THE CONNECTICUT GENERAL STATUTES.
I agree to the following statement:
I hereby certify that, to the best of my knowledge, the preceding information is true and complete. I further certify that I will report, in writing to Connecticut Innovations, Incorporated, any changes to the information contained herein.
NO FEE OR COMMISSION SHOULD BE PAID TO ANY THIRD PARTY FOR CI FUNDING. NO THIRD PARTY CAN INFLUENCE OR INCREASE THE BENEFITS AVAILABLE UNDER CI FUNDING. CONNECTICUT INNOVATIONS WORKS EXCLUSIVELY WITH ELIGIBLE COMPANIES, NOT WITH THIRD PARTIES.
Signature
Printed Name
(Required)
Title
(Required)
Today's Date
(Required)
MM slash DD slash YYYY
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