Southeast Asian and Immigrant/Refugee Small Business Stabilization Grant Application

Eligibility Process Scoring Rubric

Scoring Rubric (100 Points Total)

Severity of Impact (40 points) 31-40: Severe impact (closure, major revenue loss, staffing or safety disruptions) 21-30: Moderate impact (reduced hours, revenue decline, foot traffic loss) 11-20: Mild impact 0-10: Minimal or unclear impact
Use of Funds and Recovery Plan (30 points) 21-30 Description of how funds will be used to stabilize the business, with recovery plans if available. 11-20: General description with some clarity. 1-10: Vague or unclear use of funds and how it will help stabilize the business. 0: No plan provided.
Financial Need & Business Stability (20 points) 16-20: Strong demonstration need; grant likely to stabilize business 11-15: Moderate need 1-10: Limited need 0: Financial documentation insufficient or missing
Completeness and Accessibility of Application (10 points) 8-10: All materials submitted clearly 4-7: Minor items missing or unclear 1-3: Multiple missing items 0: Incomplete application

Applicant Information

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

County:

Please specify:

Primary Phone Number:

Secondary Phone Number:

Date of Birth:

Email Address:

Business Information

Legal Business Name:

Please match entry exactly as it is filed with the Minnesota Secretary of State's Office.

Doing Business As (DBA) if applicable:

Street Address:

City:

State:

Zip Code:

County:

Please specify:

Business Phone Number:

Percentage of Ownership:

Federal Tax ID (EIN):

If your business does not have an EIN, please include your Social Security number, as required by the IRS.

What is your 2025 business' annual gross income?

Business Structure:

Type of Business:

How many paid employees do you currently have? If you do not any employees, then please enter "0" below.

Number of full-time employees:

Number of part-time employees:

Please upload your 2024 business tax return or your 2025 financial statements, along with the most recent 90 days of bank statements.

Impact Statement

Please tell us how recent enforcement and community safety activities have affected your business and how this grant would help.

You may respond in Hmong or English, and you may submit your response in writing, video, or audio, whichever you are most comfortable with.

Business Impact: How has your business been affected? (Examples: loss of customers, reduced hours, revenue decline, staffing challenges, safety concerns.)
Use of Funds: If selected, how would you use the grant funds? (Examples: rent, utilities, payroll, inventory, security, marketing.)
Financial Need: Why is this support needed right now? (Examples: risk of falling behind on bills, risk of closure, need for stability.)

Important to Know:

There are no right or wrong answers.
Writing, grammar, or language ability will not affect your application.
All submission formats are reviewed equally.
Please keep your response under 5,000 characters (written) or 5 minutes (recorded)

How would you like to include your Impact Statement?

Please type out your Impact Statement below (5,000 characters or less):

Please upload your Impact Statement below.

Please include your 5 minute or less Impact Statement audio or video recording link (from platforms like YouTube, Vimeo, Google Drive, Dropbox, etc.) below, and a friendly reminder to make the video accessible.

Participant Acknowledgement, Release and Waiver of HAP Liability

By participating in Hmong American Partnership (HAP) programs, you acknowledge and agree to use services and resources according to all laws, rules, grant agreements, and communications by HAP staff regarding the proper uses of services and resources. You further acknowledge and agree that HAP is not responsible for misuse or exploitation of services or resources provided to you. You further release HAP from liability and waive your right to sue HAP.

By signing and submitting this form, you confirm your understanding that HAP will not be liable for any actions or outcomes arising from your participation in HAP programs.

Type your name:

Date:

Contact Information