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Local Economic Assistance Program (LEAP) Initial Application

  1. LEAP Program Application Overview

    The City is offering the Local Economic Assistance Program (LEAP) to small businesses in the community. The LEAP program is financed with Federal American Rescue Plan Act (ARPA) funds through the Department of the Treasury. Eligible businesses have the opportunity to receive up to $10,000 in grant funds. To qualify, the business must be able to show they have experienced a negative economic impact due to COVID-19 and must have 50 or fewer employees.  To find out more information and see if your business qualifies for this program, please visit or click the link below.

  2. Language Translation
    This form is available in English, Spanish, and over fifty (50) other languages. Use the Google Translate tool located on the bottom right of the screen to select your language preference.
  3. Traducción de Idiomas
    Este formulario está disponible en inglés, español y en más de cincuenta (50) idiomas. Use la herramienta ‘Google Translate’ ubicada abajo a la derecha de la pantalla para seleccionar su idioma preferido.
  4. Section 1: Applicant Business Owner Information
  5. Provide the name of the business owner. For businesses with multiple stockholders, provide name of the chief executive/administrative officer.
  6. Provide the full home address of the business owner (Number, Street, City, State, and Zip)
  7. Provide the phone number of business owner, including area code.
  8. Provide email address of business owner.
  9. Section 2: Business Information
  10. Provide the name that the business conducts business as (ie: name of restaurant).
  11. Provide the full legal name of the business entity conducting business.
  12. Provide the street address of the business.
  13. Provide the City, State, and Zip code for the business. Only Jurupa Valley businesses are eligible.
  14. Primary phone number for business.
  15. If applicable, email address that the business uses to conduct business.
  16. If applicable, provide the website for the business.
  17. If you answered "other" in the previous question about the type of business you have, please describe what your business is.
  18. Currently, how many full-time employees (40 hours per week) work directly for your business? If none, put zero.
  19. How many part-time employees (less than 40 hours per week) currently work for your business? If none, put zero.
  20. Section 3: Business Specifics & COVID-19 Impact
  21. Did you receive your Jurupa Valley Business Registration as required? If so, when? If no, you need to obtain a business registration before submitting this form. Please contact City Hall at (951) 332-6464 for more information.

  22. (3.2) How was your business impacted by COVID-19? (Check all that apply)
  23. If you selected "Other" from the question above, please describe how COVID-19 has impacted your business.
  24. Some businesses have multiple owners.

  25. Full-time employees are employees that work 40 or more hours per week. If none, put zero.
  26. If none, put zero.
  27. Enter total revenue or gross sales of the business for the period of January 1, 2019 to December 31, 2019.
  28. Enter total revenue or gross sales for the business for 2020.

  29. (3.11) How will your business use funds received through this program? (Check all that apply)*
  30. Section 4: Job Creation & Retention
  31. How many full-time LEAP-eligible jobs will be added or retained with the use of grant funds? If none, put zero.

  32. How many LEAP-eligible jobs will be added or retained with the use of grant funds? If none, put zero.

  33. Section 5: Supplemental Questions
  34. Section 6: Narrative (Optional)
  35. Please provide a statement regarding how your business was specifically affected by COVID-19, including information that has not been requested in other parts of this form.
  36. Section 7: Acknowledgement & Authorization
  37. (7.1) Authorization to Submit Application*

    By submitting this form, I understand that this grant opportunity is being provided by the City of Jurupa Valley to provide relief for businesses impacted by COVID-19. I understand that this is Phase 1 of 3 of the application process. I understand that if I receive notice that my business qualifies to participate in the LEAP grant process, I will need to provide further documentation to be verified by the City of Jurupa Valley. Receiving preliminary approval by submitting this Phase 1 application does not guarantee grant funds for my business. I understand that to ultimately receive grant funds, my business must show negative economic impacts due to COVID-19 in accordance with the Local Economic Assistance Program guidelines. By submitting this application, I am certifying that no outstanding tax liens or legal judgments against my business currently exist. I agree that by submitting this Phase 1 application, I am authorizing the City of Jurupa Valley to verify sources of income, including, but not limited to, the submittal of a record request to the California Employment Development Department and other agencies administering unemployment benefits. By submitting this form, I certify that the above statements included in this application are true and correct to the best of my knowledge. I understand that a false statement may disqualify me from benefits.

  38. Provide the full name of the person that is authorizing the submission of this form. This will serve as your electronic signature.
  39. Provide the date for the authorization/electronic signature.

  40. Leave This Blank:

  41. This field is not part of the form submission.