Locate, Grow & Stay Grant Application Let us help pay for your move to Fostoria! Applicant Full Name EligibilityDo you work full time hours as designated by the State of Ohio?(Required) Yes No (Defined by the https://codes.ohio.gov/ohio-administrative-code/rule-3357:12-3-01 ) Are you a permanent employee?(Required) Yes No Not seasonal or temporary contact Are you paid a Medicare wage or salary as reported on a Federal Tax Form W-2 for employment in Ohio?(Required) Yes No Was your employment start date on or after June 1, 2022?(Required) Yes No Start Date(Required) MM slash DD slash YYYY Hourly Wage Rate(Required) Did you become a full time employee of a Fostoria business on or after June 2, 2022?(Required) Yes No Employer(Required) Employer Representative Name(Required) HR Contact to verify employment/rate of payEmployer Representative Email(Required) Employer Representative Job Title(Required) Employer Representative Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant InformationAre you over 18?(Required) Yes No Did you relocate to Fostoria and become a full time resident of Fostoria on or after June 1, 2022?(Required) Yes No Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Proof of Fostoria ResidencyAddress (if different than above) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date applicant became a resident of Fostoria(Required) MM slash DD slash YYYY Supporting Documentation 1(Required)Max. file size: 50 MB.Include any of the following: rental lease with address listed; mortgage documentation with address listed; property tax bill; utility bill; homeowner insurance/renter insuranceSupporting Documentation 2(Required)Max. file size: 50 MB.Include any of the following: rental lease with address listed; mortgage documentation with address listed; property tax bill; utility bill; homeowner insurance/renter insuranceCompleted W-9(Required) Drop files here or Select files Max. file size: 50 MB. To process payment we must have a completed W-9 form. Please download a blank form and upload a completed one. Use the link below to download a blank W-9 form. http://fostoriachamber.com/wp-content/uploads/2024/01/W-9.pdf AttestationI hereby attest that I(Required) live within Fostoria city limits I hereby attest that I(Required) am employed full time as designated by the State of Ohio I hereby attest that I(Required) work for a Fostoria business (any business with a 44830 zip code) I hereby attest that I(Required) understand by signing the grant application and attesting to the truthfulness of my statements and documents that if it’s determined, I have been dishonest on my application this may result in legal action. Signature(Required)CAPTCHAUntitled Untitled Δ
