Form Center

2. Please complete fully and accurately. APPLICATIONS WITHOUT ALL ATTACHMENTS WILL NOT BE CONSIDERED.
4. First Name*
5. Last Name*
7. Business Name*
8. Date*
10. Email Address*
11. Phone Number*
13. Address*
15. City*
16. State*
17. Zip*
19. Income Level*
    -- Select One --Below 30% AMI: < $17,400Below 50% AMI: < $29,050Below 60% AMI: < $34,860Below 80% AMI: < $46,450
20. Age of Applicant*
    -- Select One --Under 1818 - 65Over 65
22. Gender*
    -- Select One --MaleFemaleOther
23. Race/Ethnicity*
    -- Select One --WhiteBlackAsianAmerican Indian/Alaskan NativeNative Hawiian/Pacific IslanderAmerican Indian/Alaskan Native & WhiteBlack/African American & WhiteAsian & WhiteAmerican Indian/ Alaskan Native & Black/African AmericanOther Multi-Racial
25. Is the participant a female head of household?*

    1. Yes

    1. No
27. Upload the following documents: business tax return and financials, personal tax return, W-2, entity documentation evidence (i.e., Articles of Incorporation, Bylaws, Operating Agreement, etc.), copy of driver’s license, corporate search – status active.
    APPLICATIONS WITHOUT ALL ATTACHMENTS WILL NOT BE CONSIDERED
29. Click on the link below securely upload your business tax return and financials
    Upload your business tax return and financials.

    Save your file as: First_Last_BusinessTaxReturn. *If you are a newly established business and have not filed 2020 taxes, submit only your personal Federal Income Tax.

31. Click on the link below to securely upload your personal tax return.
    Upload your personal tax return.

    Save your file as: First_Last_PersonalTaxReturn

33. Click on the link below to securely upload your W-2.
    Upload your W-2.

    Save your file as: First_Last_W2

35. Click on the link below to securely upload your entity documentation evidence. (i.e., Articles of Incorporation, Bylaws, Operating Agreement, etc.)
    Upload your entity documentation evidence.

    Save your file as: First_Last_EntityDocumentation

37. Click on the link below to securely upload your corporate search: status active.
    Upload your corporate search.

    Save your file as: First_Last_CorporateSearch

39. Click on the link below to securely upload a copy of your driver's license.
    Upload a copy of your driver's license.

    Save your file as: First_Last_License

41. I have uploaded ALL of the above required documents.*

    1. Business Tax Return
    2. Personal Tax Return

    1. W-2
    2. Entity documentation Evidence

    1. Corporate Search
    2. Driver's License
43. Certify the below:*

    1. I certify that the information given to the City of Dubuque, is to the best of my knowledge and belief, true, correct, and complete as stated herein.

    I am aware that the information being provided is subject to verification by the local or federal government. I also understand that false statements of information are grounds for denial of assistance.
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field