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2. The American Rescue Plan Act (ARPA) Non-Profit Emergency Relief Fund was approved by the Hyattsville City Council to provide economic relief to non-profit organizations that provide all or a primary portion of programs and services in the City of Hyattsville, and for the benefit of the City of Hyattsville. The fund includes $900,000 to support eligible non-profits, with awards of up to $25,000 per organization. Eligible applicants who are suffering financial hardships due to COVID-19 are encouraged to apply. Funds will be awarded on a first-come, first-served basis. Applicants must be able to provide proof of eligibility for the grant program. There are no restrictions on the use of grant funds, if awarded. Applicants will need to submit a W-9 form for payment. 

   
   

   For assistance with this application, please review the Frequently Asked Questions at: www.hyattsville.org/rescueplan 

   
   

   Please contact American Rescue Plan Program Manager Patrick Paschall at ppaschall@hyattsville.org or (301) 485-6924 for questions. Please allow up to 30 calendar days to process grant applications.

   
   

   Para ver esta información en español, seleccione el boton 'select language' ubicada abajo de esta pagina. 

4. General Information:
6. Organization Name:*
8. Contact Person: *
10. Street Address:*
11. Suite:
13. City, State, Zip: *
15. Phone #: *
16. Alternate Phone #:
18. Email:*
20. Description of your organization: *
22. In February 2020, was the organization fully operational and providing services within the City of Hyattsville? *

    1. Yes
    2. No
24. As of the date of the application, is the organization fully operational and providing services within the City of Hyattsville? *

    1. Yes
    2. No
26. YOUR ORIGANIZATION IS NOT ELIGIBLE

    1. I understand I am not eligible.

    The Non-profit Emergency Relief Program is only available to non-profit organizations that were operating in February 2020 and are currently in operation. 

    By selecting "No," you have indicated you are not eligible for the Non-Profit Emergency Relief Program.

28. Upload Form W-9*

    All applicants are required to submit a federal Form W-9 in order to receive payment. You can download a copy of the form at: https://www.irs.gov/pub/irs-pdf/fw9.pdf

30. The Non-Profit Emergency Relief Fund is available to non-profit organizations organized under Sections 501(c)(3) and 501(c)19 of the Internal Revenue Service Code. Please indicate which Section of the IRS Code your organization is organized under, and provide a copy of your IRS Nonprofit Status Letter. *

    1. Section 501(c)(3)
    2. Section 501(c)19
    3. Neither – my non-profit is organized under another section of the Code, such as 501(c)(4) or (6)
32. Please upload a copy of your IRS Determination Letter indicating your non-profit status.*
34. Is your organization in Good Standing with the Maryland Department of Assessments and Taxation? *

    1. Yes
    2. No

    Check here: https://egov.maryland.gov/BusinessExpress/EntitySearch/Search  

36. Applicants must demonstrate they provide all or a primary portion of programs and services in the City of Hyattsville, and for the benefit of the City of Hyattsville. Preference will be given for organizations with locations inside the incorporated bounds of the City. Please indicate what proportion of your organization’s programs and services are located within the incorporated City of Hyattsville, and how these activities are for the benefit of the City of Hyattsville. You may attach supporting documentation. *
38. (Optional) Upload Supporting Documentation Here:
40. Please indicate the type of financial harm your organization experienced due to COVID-19. *

    1. Decrease in Revenues
    2. Financial Insecurity
    3. Increased Costs (including uncompensated increase in services)
    4. Challenges covering payroll, rent, utilities, or other operational costs
    5. Did not experience financial harm

    *Note: The Non-Profit Emergency Relief Fund is only available to non-profits who can demonstrate that they experienced financial harm during during the pandemic.

42. All applicants must provide IRS Form 990 for the years 2019, 2020, and 2021, showing the type of financial harm indicated above. Applicants must provide all three years’ tax forms.
44. Please upload the 2019 IRS Form 990 here.*
45. Please upload the 2020 IRS Form 990 here.*
47. Please upload the 2021 IRS Form 990 here.*
48. (Optional) Submit additional supporting documentation here.
50. Amount Requested:*

    * Award amounts are limited to the actual harm established, up to $25,000.

52. CERTIFICATION: The information provided in the application and this self-certification form are collected to determine if my organization is eligible to receive assistance provided through the Federally-funded City of Hyattsville Non-Profit Emergency Relief Program. I certify that all the information provided in this application is correct and complete to the best of my knowledge, including all information regarding my non-profit organization. I understand that providing false statements constitutes an act of fraud and is grounds for termination of assistance and is punishable under Federal and State of Maryland laws. I understand the information provided in my application may be shared with the United States Department of Treasury and other appropriate Federal agencies responsible for oversight of Federal funds.*
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54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field