Name *

First Name

Last Name

Phone

(###)

###

####

Qualification *

Please verify the following:

Business/Artist is locally owned and located in San Luis Obispo County

If funded, business/artist agrees to provide requested impact data to Reprise within a reasonable timeframe. (Ex. Number of students impacted, demographic information, data pertaining to how the business was able to grow as a result of the funding, etc.)

Demographics

Check any that apply. These questions are optional and your responses can be helpful in qualifying Reprise for additional funding opportunities such as grants.

This business is military/veteran owned/ Artist is active or former military/veteran.

This is a new business (less than 1 year in operation)

This is an established business (more than 5 years in business)