Business Recycling Grants Application Form
2016
Business Recycling Grants
Application Form
E-mail completed 1) application, 2) W9 form, and 3) Grant Budget spreadsheet to:
andre.x.xiong@hennepin.us
Applicant Information
Organization Name:
Registered Business Name: (if different than “doing business name”)
Address:
Company Phone:
Contact Name:
Website:
Title:
Direct line or extension:
E-mail:
Authorizing Person
Authorizing person who has the authority to enter into a contract on behalf of your organization (e.g.
owner, manager, building manager, executive officer, or director)
Contact Name:
Title:
Direct line or extension:
E-mail:
Budget Summary
Total Grant Request
$
*From Grant Budget Spreadsheet (remember to submit as a
separate document. Use correct Option 1 or Option 2 form found at
www.hennepin.us/businessrecycling)
*If grant request exceeds $10,000, submission deadlines apply:
February 15, June 15, and October 15
Project Summary
Describe what your organization does:
your answer here
See Grant Guidelines for information on eligible and ineligible expenses. Use separate Grant Budget Spreadsheet to
calculate budget and remember to include it with your application.
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Business Recycling Grants Application Form
Number of employees at proposed project site(s): your answer here
Project description:
 Please note that projects must be completed within 12 months from the start date for
Option 1 and 18 months for Option 2
 Project expenses cannot be reimbursed unless they are made after a contract is
approved and returned. Please see Grant Guidelines for a list of eligible expenses.
Project objective (please check all that apply)
☐ Start recycling
☐ Start organics recycling: ☐composting; ☐ food-to-people; ☐ food-to-livestock
☐ Improve existing recycling
☐ Improve existing organics recycling: ☐composting; ☐ food-to-people; ☐ food-to-livestock
Narrative: (5 or more sentences)



Describe the current state of your recycling program(s). Why and how does it need to be
improved?
Explain how you will use the containers and/or grant money to improve your program
How will staff and/or customers will be trained to comply with a new program?
your answer here
Please identify the key people who will be involved in your project. Please name the individuals
for the roles given and/or adjust the list as needed.
Task or role
Responsible Individual(s)
Contact information
(Name, Title)
Primary contact- communicates
with Hennepin County regarding
your grant
See Grant Guidelines for information on eligible and ineligible expenses. Use separate Grant Budget Spreadsheet to
calculate budget and remember to include it with your application.
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Business Recycling Grants Application Form
Report writer (if different from
primary contact)
Property manager or
management company
Operations manager or Facilities
manager
Custodial supervisor
Foodservice supervisor
Green Team leader
Health and Safety supervisor
(right click and insert rows as
needed)
Is there an environmental committee, green team, sustainability coordinator or sustainability
policy on the topic of waste and recycling? If yes, include a description of goals, mission
statement, responsibilities, etc.
your answer here
Current Waste Management Overview
Waste data is required at the beginning and end of your grant period.
Current Waste Hauling Service Data (required)
Waste hauling service, or pickup, levels are one way to track project results. Check your
waste hauling invoices or call your waste hauler to obtain cost and service levels to complete
the following table. Insert rows as needed.
Volume/size Number of containers
Cost of service
Fullness
# of pickups
& container type
(yards,
(cost per month. If
(best
per week
gallons)
(#, dumpster, cart or
other billing cycle,
estimate)
(1-7 or on call)
compactor)
please specify)
Examples:
30 cubic
yards
1 compactor
96 gallon
3 carts
On call,
average 2x a
month
5x/week (M-F)
$100/pickup (usually
twice a month)
100% full
$200/month
Each cart
1/2 full at
pickup
Trash disposal
Recycling
Cardboard recycling (if collected separately)
See Grant Guidelines for information on eligible and ineligible expenses. Use separate Grant Budget Spreadsheet to
calculate budget and remember to include it with your application.
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Business Recycling Grants Application Form
Organics recycling
*If the table above does not reflect your typical hauling level (e.g. seasonal closure, large
construction projects, etc.) please use the box below to explain how your normal levels would
compare.
your answer here
Weight data from hauler (optional but encouraged): Some haulers will provide this information
as a part of their service; others will provide it for a fee.
Waste stream
Weight
Time period
Method of weighing (truck
(lbs or tons)
(month/year)
scale, average, volume estimate)
Trash
Recycling
Cardboard recycling
Organics
Sustaining the Project
Describe actions, such as continued education, policy changes and budgeting, that your
organization will take to sustain the project after it is completed without additional funding from
Hennepin County (at least 3-5 sentences).
your answer here
See Grant Guidelines for information on eligible and ineligible expenses. Use separate Grant Budget Spreadsheet to
calculate budget and remember to include it with your application.
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