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					                                    North Carolina
                                Department of Commerce
                             Rural Development Division
               Certified Retirement Community Program Application
                        4313 Mail Service Center, Raleigh NC 27699-4313
                           Phone (919) 571-4900 • Fax (919) 571-4951

This application becomes public record and is subject to disclosure. With few exceptions, you have the
right to request and be informed about the information that the State of North Carolina collects about
you. You entitled to receive and review the information upon request. You also have the right to ask
the state agency to correct any information that is determined to be incorrect. Reference NC General
Statue 132-1.
                              Table of Contents

1. Table of Contents---------------------------------------------------- Page 2

2. Application Summary Form-------------------------------------- Page 3-4

3. Introduction---------------------------------------------------------- Page 5

4. Eligible Guidelines-------------------------------------------------- Page 5

5. Assessment------------------------------------------------------------ Page 6-11

6. Technical Assistance------------------------------------------------Page 11

7. Application Submission Process-------------------------------- Page 12

8. Certified Retirement Communities Scale--------------------- Page 13

                   Applicant Information                                        Office Use Only
Section 1                Town Applicant Name                                    Date Stamp

                   Comptroller (in-state) Taxpayer ID No.
                                                                                Received by

                   Chief Elected Official
                   Title          First Name                      M.I.      Last Name
       Section 2

                   Primary Phone                                  Fax Number
                   (     )                                        (    )
                   E-mail                                         Web Address

                   Mailing Address

                   City                                           State                       Zip Code

             Local Contact Person
             Title & First Name                               M.I.        Last Name

             Position Title                                   Primary Phone
                                                              (     )                         Ext.
             E-mail                                           Fax Number
                                                              (     )
             Mailing Address
              Chief Elected Official
Section 3

             City                                                              State     Zip Code
             Facility Address – Physical Address
             Physical Address (not P.O. Box)

             City                                                              State     Zip Code

Sec. 4       Population Information (Census Population based on latest official census)
             Exact population __________________________

             Payment = Exact population ____________________ x .50 cents or $10,000.00
             (whichever is the higher amount) = $ ___________________________
             Method of Payment:
              (payable to North Carolina Department of Commerce)               Amount Remitted
                                                                             $ ________________
                       Check No. ____________
                      Cashier’s Check No. ____________
Section 5

                                                                                  OFFICE USE ONLY
                      Money Order No. ____________                                Sent to Fiscal _____________

             Mail payment with application to:
                                      North Carolina Department of Commerce
                                          Certified Retirement Community
                                               4313 Mail Service Center
                                               Raleigh NC 27699-4313
             FISCAL USE ONLY Fiscal Receipt No.
               4301-1650-2200        Date Receipt Issued             /      /

             Chief Elected Official Signature
             The applicant, by and through his/her personal or agent’s signature below (1) certifies that all
             information provided in connection with this application at any time is true and correct to the
             best of the applicant’s knowledge; (2) acknowledges that any misrepresentation or false
 Section 6

             statement made by the applicant, or an authorized agent of the applicant, in connection with
             this application, whether intentional or not, will constitute grounds for denial, revocation, or
             non-renewal of any certification issued pursuant to this application. If signed by an agent
             (including employee) of the applicant, the person signing certifies that he or she is authorized
             to make the preceding certification on behalf of the applicant.
             Chief Elected Official Signature                                Date (mm/dd/yyyy)
                                                                                   /          /20

The Objective of the North Carolina Certified Retirement Community Program (CRCP) is to
encourage retirees and those planning to retire the opportunity to make North Carolina their
home and promote the state as a retirement destination; assist North Carolina communities in
their efforts to market themselves as retirement locations; assist in the development of retirement
communities and continuing care facilities; and to encourage mature market travel and tourism to
North Carolina to evaluate future retirement desirability (GS 443b-431.100).

The North Carolina Department of Commerce, Community Investment and Assistance along
with Travel and Tourism have joined resources to provide the tools necessary for Certified
Retirement Communities to attract and encourage retirees to choose North Carolina as their
retirement home.

Eligible Guidelines
   1) Most be an incorporated town, municipality, or city;

   2) Must be able to describe organizing process and why the community has chosen to apply
      for the certification. Provide any relevant planning including committee structure
      (committee must meet six (6) months minimum threshold prior to applying).

   3) Submit a marketing strategy specifically for retiree attraction

   4) Describe how local unit of government is engage with committee

   5) Describe how committee is engaged with community awareness relative to this effort.

   6) List other partners engaged with the committee

   7) Submit application fee along with the application

   8) Submit supporting rational with application (not to exceed 15 double-spaced typewritten
      pages at size 12 font) submit in word or PDF format only

Population – County _______ City / Town ________
Persons under 18 years old, percent from 2007-Co.______ City/Town_____
Persons 65 years old and over, percent from 2007-Co.______City/Town____
Households, from 2010 census - County________ City/Town________
Persons per household, from 2010 census – County _____City/Town______
Median household income - County _________City/Town__________
Diversity, percent from 2010 census
     White - County_________ City/Town_________
     Black – County________ City/Town__________
     American Indian – County________ City/Town_________
     Asian – County________ City/Town_________
     Hispanic or Latino- County________ City/Town________
Crime rate per thousand – County___________ City/Town__________
Exact population __________

HOUSING / Technology
What is the median sale price of a two-bedroom home? _________
What is the median sale price of a three-bedroom home? _________
How many homes, as of this date ______________, do you have for sale in
the following ranges?
    $60,000-$149,000 _______
    $150,000-$300,000 _______
    Over $300,000     _______
Are quality apartments available? _______ Median monthly rent? ______
Are condos/town homes/garden homes available? _____ Median price?
Are there retirement communities in your area? _____
    Active Living _____
    Continuing Care _____
    Assisted Living _____
Does your community have Broad band (DSL, Cable Modem, Wireless,
Satellite ___________
Dial up Service _______     Cellular Service _______

Number of hospitals in your community? ______ # of beds _______
Number of regional hospital systems in a 30-mile radius? _______
Specialists in your community:
  # of Cardiologists           _______
  # of Oncologists             _______
  # of Orthopedics             _______
  # of Physical Therapist      _______
Does your hospital provide emergency transportation to a trauma center?
Number of home healthcare providers in your community? __________
Immediate care facility other than an Emergency Room available?
Number of dentists in your community? __________
Hearing aid center available? _________
Number of pharmacies? _____
Number of exercise facilities or wellness centers in your community?
Number of Physicians _________

What are current property tax rates? City ______ County _______
What is the property tax on a $100,000 home? City _____ County _____
What is the current sales tax rate? _____
Are there special property tax exemptions for seniors? _____
Personal tax exemptions? ________
Housing or homestead exemptions? __________
Discount for retirees (entertainment, medicines, and food) available?
Number of banks? _________
Number of accountants? _______
Number of financial planners? _______
Cable and satellite services offered? ________
Broadband Internet service available? _________
Retail Offerings (please check):
_____ Downtown Shopping District
_____ Big Box Retailer (Wal-Mart, Big K, Target, Lowes)
_____ UPS/Fed Ex Package Store

_____ Farmers Market (local)
_____ Pharmacy (Chain or Independent)
_____ Department (Clothing , Shoe) Stores
_____ Package Store
Are there local employment opportunities for retirees ?(full / part- time
and business opportunities available in a variety of trades, professions and
services) _________
_____ Bookstore: Local or Chain? ______
_____ Children’s Clothing
_____ Fast Food
_____ Family Dining
_____ Fine Dining
      How many serve alcoholic beverages? _______
Personal Services (Please check):
_____ Lawn care
_______ Personal shopper
_____ Laundry service
_____ Dry cleaning service
Distance to nearest major shopping mall? ______
Distance to International airport(s)? ______
Distance to Regional airport(s)? ______
Distance to nearest Military base? _______
Distance to nearest Fire Station ________
Distance to nearest Police Station _______
Number of parks?_____          Please list by name in the appropriate category
  City/County parks:
  State parks:
  National parks/forests:
  Wildlife refuges:
Number of trails? _____
  Greenways & Birding:
Number of golf courses? _____
Number of historic sites(including historic homes)

How many bodies of water?
    Boat Launches:
Are there sporting opportunities to include watching or participating
Wineries/vineyards available in your community? ______
Number of museums? _____
Number of art galleries? _____
Number of libraries? _____
Is there community theatre? _____
What other types of performing arts?

List local festivals & celebrations (community or ethnic):

Is there an active arts society?
What other venues are listed in the Official NC Travel guide that is not listed above?

Is there public transportation? ________ What type? Buses ____
Train _____ Taxes ______ Shuttles ______

Are there special transportation services (dial-a-ride or other services for
banking, shopping, etc.)? _____________
Number of travel agencies? ______
RSVP (Retired Senior Volunteer Program) available? ______
SCORE (Senior Corp of Retired Executives) Chapter available? _____
COMMUNITY / Education /Military
Is there an active Chamber of Commerce?
Is there a Convention & Visitors Center or Tourism Info Center? _______
Is there an Economic Development Organization? ______
Is there a Retiree Recruitment Program? _______
    If so, is there a current plan in place? _______ Is there staff? _______
    Is there specific literature for the recruitment efforts? _______
Is there continuing education for retirees? _______
What type of education does your community have: University _______
No. miles _______ Community College ______ No. miles ______
Continuing Education _______ No. miles _______
Is there a military base(s)? _______ if yes, how many miles 0-99 _______
100-250 _______

What is unique about this community that makes it especially appealing to

List the major strengths for retirees in this community:

                                        - 10 -
List things the community would consider enhancing to make them more
attractive to retirees (add additional pages, if necessary):

Describe this community’s climate.


Technical Assistance

Technical assistance is available prior to the application being submitted. Technical Assistance
will be provided by Community Development Division staff. There may a cost associated with
the technical assistance if staff has to travel to potential communities. Cost will consist of travel
and per diem.

                                                - 11 -
Application Submission Process

The Department of Commerce, Community Investment and Assistance will accept applications
in January and July of each calendar year. The first round of applications will due by January
31, 2012. The second round of applications will be due by July 31, 2012.

Applications received will be reviewed within 90-120 days of receipt by the CRCP Committee.
Communities will be selected based on the information in the application consistent with the
requirements of the factors listed in Senate Bill 143B-437.100. The CRCP Committee has
established a rating scale for your review. This rating scale is included in the application.

Applicant must submit two (2) complete copies of the application to Community Investment and
Assistance. Both copies must be complete and have original signature of the chief elected
official on the application summary form.

Applications should be mailed to:
Charlie Thompson,
Senior Community Development Officer
Department of Commerce
Community Investment and Assistance
4313 Mail Service Center
Raleigh, North Carolina 27699-4313

Delivered to:
Community Investment and Assistance
Anderson Plaza
100 E. Six Forks, 2nd Floor
Raleigh, N.C. 27609

                                             - 12 -

Section                           200 points

Demographics                      15
Housing /Technology               25
Healthcare                        40
Local Economy                     40
Leisure/Cultural Opportunities    40
Services for Retirees             25
Community /Education /Military    15

Total                            200 points

                                    - 13 -

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