V3 Grant Application

V3-Certified Companies are eligible to receive up to $10,000 in grant funding to support Veteran employment. Learn more by visiting the V3 Grant section.

Information contained in this form is not subject to Freedom of Information Act Requests in accordance with Code of Virginia § 2.2-3705.1 and § 2.2-3705.6(3). All information will be handled in accordance with the Privacy Act of 1974 (5 U.S.C. § 552a) and applicable Virginia statutes.
Eligibility for this grant is dependent upon condition of (a) being a V3-certified company; (b) total number of employees in the business is equal to or fewer than 300; (c) the Veteran identified has been employed with the company for at least one year since July 1, 2014; (d) the Veteran identified has been employed in a full-time capacity; (e) the Veteran identified had been discharged from active military service within five (5) years of the beginning of his or her employment; (e) the business has not received greater than $10,000 in grant awards from this fund during the current fiscal year (Jul 1 - Jun 30).
Company Information
1. V3 Company Name*

Enter your company’s formal business name, as registered with the Internal Revenue Service or Virginia Department of Taxation.
2. Employer ID Number*

Enter your company’s employer ID number, as registered with the Internal Revenue Service.
3. Company Size ( Select One )
Select your company size from the options below. Per the State Budget, only those companies with 300 or fewer employees under common control at the time of application are eligible for this grant. Business size designations listed are defined in accordance with the program guidelines for the Virginia Values Veterans Program.
Veteran Information
4. Name of Eligible Veteran*
Enter the full name of the Veteran for which this grant is eligible, as it appears on their W-2.
Last Name*
First Name*
Middle Initial*
5. Veteran Hire Date*
MM slash DD slash YYYY

The Veteran Hire Date should reflect the date in which the eligible Veteran began his or her status as a full-time employee (mm/dd/yyyy).
6. Location Employed*
Enter the City and State in which the eligible Veteran was employed since his or her full-time employment.
City*
State*
7. Veteran Discharge Date*
MM slash DD slash YYYY

Enter the Veteran’s discharge date, as it appears on his or her DD-214, from active military service (mm/dd/yyyy).
8. Current Employment Status*
Select from the available options whether the Veteran for which the grant is eligible is a full-time employee, full-time equivalent employee, part-time employee, or other.
Other*

Describe the employment status of the Veteran identified
9. Veteran Salary*

Enter the annual salary of the eligible Veteran, starting from his or her status as a full-time employee.
Applicant Information
11. Applicant Name*
Enter your full name, or the full name of the party completing and signing this application, which will also serve as the point of contact between V3 and the applying business.
Last Name*
First Name*
Middle Initial*
11. Applicant Job Title*

Enter your job title, or the job title of the party completing and signing this application.
12. Applicant Phone Number*

Enter the best number at which the V3 program may reach you or the signatory of this application.
13. Applicant Email Address*

Enter a working email address at which the V3 program may reach you or the signatory of this application.
Signature
14. Date of Application*
MM slash DD slash YYYY

Enter the date this application was signed
The information in my application is correct to the best of my knowledge.*
- I confirm
By checking this box and submitting this form, you or the signatory of this application certify that all information contained herein is true and correct, and is subject to verification at the discretion of the Commonwealth of Virginia.
Companies must include with this application
Please upload your Veterans Form DD 214, specifically the MEMBER-4 page.*
Max. file size: 8 MB.
Completed W9- MANDATORY*
Commonwealth of Virginia Substitute Link
Submit the Commonwealth of Virginia W-9 form with your application from the direct link above this sentence. FAILURE TO SUBMIT THE ATTACHED W-9 WILL DELAY YOUR APPLICATION STATUS, UNTIL THE CORRECT W-9 FORM HAS BEEN SUBMITTED.
Accepted file types: pdf, Max. file size: 8 MB.
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Forms

V3 Grant Application

Company Information

Veteran Information

Applicant Information

Signature

Companies must include with this application