The City of North Adams has engaged the Franklin County Community Development Corporation (FCCDC) to administer this new small business (forgivable) loan program in support of the continued operation or re-opening of small businesses that are dealing with the negative economic impacts of the COVID-19 pandemic.

The goal of this program is to make funds available to small businesses disrupted by the COVID-19 pandemic until they are able to access the other programs and/or restore revenue streams and cash flow.

Forgivable loans of up to $10,000 for business expenses such as working capital, rent, staffing, utilities, technical assistance, general support and stabilization of the business. This loan is forgivable after issued as long as the business provides documentation that the funds have been spent in line with the presented budget and the owner certifies that they have not received nor will they receive funds for these expenses from other funding programs.



Please be sure that you have filled out the following as you will need the information from these forms to complete this application.

          FAMILY INCOME WORKSHEET (for each owner over 20%)

          COVID 19 LOSS:PROFIT AND LOSS WORKSHEET 2019/2020 comparison





Business Name*
Business Address*
Business City
Business Zip*
Business Phone*


Confirm Email*
Personal Phone*
Preferred contact method
  • cell phone
  • business phone
  • Personal phone


This section confirms that this business meets the minimum basic eligibility criteria of this program. If it does not meet these requirements, please contact the for information on other assistance programs.

Do you have five (5) or fewer employees on the date of this application? (Include part-time, full-time and all owner(s)?*
  • Yes, 5 or fewer
  • No, 6 or more - This business is not eligible for this program
How is your business structured?*
Was your business in operation prior to January 1, 2019?*
  • Yes - Business was started prior to January 1, 2019
  • No - - Business was started after January 1, 2019
Does your business provide goods/services to multiple clients or customers? *
  • Yes
  • No - this business is not eligible for this program
Is your business current with all state/municipal taxes through 3/1/2020 (or have a workout plan)?*
  • Yes
  • No - this business is not eligible for this program
Is your business current with all required licenses and registrations at the state and municipal levels?*
  • Yes
  • No - this business is not eligible for this program
Is your business a party to litigation involving the state or municipality? *
  • Yes - this business is not eligible for this program
  • No
Is your business registered with the city/town in which it is located? Applicants' businesses, or your registration has lapsed, please register or renew as soon as possible. *
  • Yes
  • No - this business is not eligible for this program
Are all the business owners over the age of 18?*
  • Yes
  • No - this business is not eligible for this program
Check the Business Industry that best fits: *
Type of Business - other
Please list names of all Business Owners with 20% or greater ownership
Income ELIGIBILITY: Using the FAMILY INCOME WORKSHEET for each owner, please answer the following questions for owners with more than 20% ownership. If you have questions about the FAMILY INCOME WORKSHEET, please contact


The information regarding race, natural origin, sex designation, marital status, disability status and veteran status on this application is requested in order to assure the Federal Government, acting through the Department of Housing and Urban Development, that Federal Laws prohibiting discrimination against program applicants on the basis of race, color, national origin, religion, sex, familial status, age and disability are complied with. While you are not required to furnish this information, you are encouraged to do so.


Please complete this section for yourself (the other owners will be asked to complete a demographic form later)

  • Female
  • Male
  • Prefer not to answer
Ownership Check all that apply
Check all that apply (this business owner)*
Check one of the following that best applies to you:*
If you prefer to identify differently, please do so here


Does any owner currently work for the city where the business is located, or hold a position on a board or commission in that city/town (potential conflict of interest issues)? Does a family member or relative work for the city or town where the business is located, or hold a position on a board or commission?
If yes, what city and what position(s)?


What is happening to your business now? Check all that apply
How did COIVD -19 impact your business? Tell us about jobs, sales, inventory, supply chain, general operations, PPE, technical issues, new regulations, mandatory shutdowns etc. See FAQ for details*
Using your PROFIT AND LOSS FORM, indicate the estimate loss your business has experienced since March 10, 2020
  • Less than $1,000
  • Between $1,000-$5,000
  • Between $5,000-$7,500
  • Between $7,500-$10,000
  • Over $10,000
Amount Requested (Please enter numbers only, no $)
If awarded the forgivable loan, what will these funds be used for? Check all that apply. *

NOTE that these funds MAY NOT BE USED FOR:

major equipment purchases purchase of real property, construction activities, business expansion, or lobbying.



Timeline for use of funds
Do you have a loss of income equal to or greater than the requested assistance due to COIVD-19?
  • Yes - the income lost is greater or equal to the amount requested
  • No - the income lost is less than the amount requested

The Community Development Block Grant (CDBG) Program’s goal is to develop viable communities by providing decent housing and a suitable living environments, and by expanding economic opportunities, principally for persons with low- and moderate-incomes. 

The CARES Act is specifically for adverse impacts due to COVID-19.

How, if at all, does your business support the basic needs (food, water, clothing and shelter, transportation, sanitation, education, and healthcare) of residents who are of low and moderate income?
What makes your business unique and special in the local community (neighborhood, town, region)?
Describe any business changes or improvements (adding products and/or services, developing new strategies or tactics), that you plan to implement using these funds.
How did you determine that these expenses are reasonable for this program?
How will this assistance stabilize your business to prepare /prevent/ respond to COVID-19? What will this assistance help your business accomplish?
Did you apply for and/or receive the following: Check all that apply


Certifications: Check all that you agree to.
Authorized Signer for Business*
Additional Comments

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