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2. The American Rescue Plan Act (ARPA) Food Assistance Program was approved by the Hyattsville City Council to support programs that provide free meals to City of Hyattsville residents. 

   The fund includes $200,000 to support eligible non-profits providing free food service to residents in the City of Hyattsville, with awards up to $25,000. Funds will be awarded on a first-come, first-served basis. Applicants must be able to provide proof of eligibility for the grant program. 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. 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

24. The Food Assistance Program 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
26. Please upload a copy of your IRS Determination Letter indicating your non-profit status.*
28. 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  

30. Is your organization able to provide quarterly program reports, including summaries of program activities, expenses, and any necessary supporting documentation, in compliance with federal requirements as subrecipients of federal grants? *

    1. Yes
    2. No
32. Upload proof of general liability insurance.*
34. Project Name*
36. Description of the project:*
38. (Optional) Upload Supporting Documentation Here:
40. Narrative description of how the program serves Hyattsville residents: *
42. (Optional) Upload Supporting Documentation Here
44. Describe the organization’s capacity to execute the project (e.g. previous similar projects executed, currently running this program, etc.): *
46. (Optional) Upload Supporting Documentation Here
48. Expected Number of Hyattsville Residents Served*
50. List other sources of funding for the project (if any):*
52. Amount Requested:*

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

54. Applicants must provide a proposed project budget. Please upload a project budget here:*
56. 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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58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

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