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SMALL BUSINESS SCHOLARSHIP PROGRAM As part of the support of existing businesses, Monument will reimburse licensed small and home-based businesses 50% of the pre-approved tuition and material costs (excluding travel), up to $300 annually per business. The Small Business Scholarship Program is limited to owners and employees of businesses with 25 or fewer full-time equivalent employees. Businesses must be operating within the legal limits of the Town of Monument and have a valid Monument business license. Home-based businesses must have proof of Town residence, a valid Monument business license, and be participating in entrepreneurial training/small business development courses. **Small Business Scholarship program is subject to funding availability. Funding is determined on a first come, first served basis.** Applicant Information Person taking the course is: Name of Business: Nature of Business: Business Address: City State Zip Code Business Phone: Email Town of Monument Business License Number: Sales Tax License Number Course Information Name of course to be taken: School/institution providing course: Provide a brief description of the course (attach course description): ---PAGE BREAK--- 2 Describe how this course will assist your business plans: Start date of course: Completion date of course: Cost of course: Cost of materials: *Cost of course and cost of materials must be greater than $50 to qualify for reimbursement* Submittal Requirements Checklist - Incomplete submittals will not be accepted [ ] Completed application [ ] Copy of Course Registration Confirmation [ ] Proof of payment for the cost of course and cost of materials Prior to the processing of the reimbursement by the Town, proof of course completion will be required. Instructions Complete entire application carefully and accurately and return to: Town of Monument Attn.: Portia Hermann 645 Beacon Lite Rd Monument, CO 80132 ---PAGE BREAK--- 3 Certifications By signing below, the Business Owner/Approving Manager and Participant (applicant) understands and agrees to the following: 1. All information contained in this application, the attached exhibits and other materials submitted in connection with this application are true and accurate to the best of the applicant’s knowledge. Applicant understands and agrees that false or untruthful information may be grounds for the Town to stop processing this application or to withdraw any approval previously obtained based in whole or in part on such false or untruthful statements. 2. The Town is under no obligation to approve the request contained in the application. No promises of approval are conveyed with the acceptance of this application. 3. All tax obligations to the Town of Monument and El Paso County are current. Signature of Business Owner/Manager Approving Course: Signature of Participant Taking Class (If Other Than Business Owner/Manager): Town of Monument Use Only Date Received: Date Application Approved: Tuition Cost: $ Materials Cost: $ Amount to be reimbursed: $ Approved By: