Letter of Agreement 501C3 Individual by bmt16897


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									                                                                                TAB 1                                                                         1 of 12

                            GUIDE To All 2008-2009 Funding Announcement Forms ("App-2008-2009" Workbook)

      This Workbook is to be used in conjunction with the separate August 2008 Funding Announcement for funding provided, in part, under
      the Microenterprise Development Act (LB 327).

  When opening for the first time, use the Save/As command to save this file with a different name. It would be helpful to the Nebraska Enterprise Fund if
                                   you would use "R12AP-XYZ-08-089xls" (where XYZ = your organization's short name).

     A complete application includes all required Forms included in this Workbook, a proposal narrative (3-6 pp), updated business plan, copy of 501c3, evidence of
received and committed match, map of service area and audit. Specific explanations from instructions are now provided in many of the cells; simply float the
mouse cursor over cells with a red triangle in upper right corner and instructions will appear.

  1   Excel 2003: This Workbook requires the use of Excel 97 or a later version. NEF uses Excel 2003.
  2   On-screen use: The forms are designed with two different shaded areas to guide data input. Information you supply goes into YELLOW -shaded
      cells only . GRAY-shaded cells are formulas designed to automatically perform simple calculations. <>
  3   Columns/rows: Row #'s (in Col. A) are NOT the same as the spreadsheet row #'s. Column #'s are the same.
  4   Edit carefully: No cells are protected so you need to be careful not to delete already-existing text, numbers or formulas unintentionally. <>
  5   Linked cells: Some cells in separate worksheets are linked to other worksheets in the Workbook. This is used only when information is identical,
      and designed to save you from re-keying the same text or numbers. Since no cells are protected, you can overwrite this linkage by simply entering
      new input. <>
  6   Inputting text: Some cells request text: try to make answers as short as possible or reduce the font size (Format/Cells/Font). Do NOT widen or
      add columns or the form may not fit within page margins and will not print properly. You may add additional rows if necessary; use the "Insert/Row"
      command, but double-check formulas to make sure that new rows are properly added. <>
  7   "Official" hard copy: After you complete and e-mail the application, print a hard copy, signe where required, and mail/fax to NEF by the
      "postmarked" deadline. Your signed hard copy, will become part of your official application. <>
  8   Use the following chart to determine which forms you must complete for the funding you are seeking.

                                                                                 Core Programs                     Special Program             Evergreen Loan
      Tab# / Forms:                                                         Core I           Core II                   Grants                    Application
      Tab 3. Operating Grant Budget Form            (must be signed)          yes                 yes                     yes                         yes
      Tab 3, Box 4. Outcomes                                                  yes                 yes                     yes                         yes
      Tab 4. Community Impact & Activities                                    yes                 yes                     yes                         yes
      Tab 5. Milestones                                                       yes                 yes                     yes                         yes
      Tab 7. Evergreen Loan Application             (must be signed)                                                                                  yes
      Tab 8. Geographic Areas Served                                          yes                 yes                     yes                        yes
      Narrative                                                               yes                 yes                     yes                        yes
      Business Plan                                                           yes                 yes                     yes                        yes
      Audit                                                                   yes                 yes                     yes                        yes
      Program Director's Resume                                               yes                 yes                     yes                        yes
      Loan Policies and Procedures                                                                                                                   yes

                                                                           TAB 2                                                                        2 of 12

                                          INSTRUCTIONS to the Operating Grant Application

Overview:                Read "GUIDE" (Tab 1) before starting forms.
    Instructions have been inserted within most cells. Float mouse across cell with red triangle in
    upper right corner and the comment box will appear.
 A   Tab 3, Boxes 1-4, must be completed by all applicants <>
 B   The on-screen version of this worksheet, like others in this R12-AP-2008-2009 Workbook, includes two types of shaded cells. On-screen
     users should fill in the yellow-colored cells. The shaded dark cells contain formulas and should fill in automatically as data is entered. (Hard-
     copy users should fill in all shaded areas. <>
 C   The "Total Project Budget" in Column G should be the 12-month budget for the entire microenterprise program for delivering lending and/or
     training & technical assistance. Column H is limited to how your program would use LB 327 funds under the accompanying proposal. NOTE:
     Col H, Line 57 is the AMOUNT OF YOUR LB 327 REQUEST under this proposal. Column I, Line 57 will fill automatically when you complete
     Box 3. <>
 D   Many of the terms used in this application packet can be found in the packet's "Glossary." <>
 E   Be sure to explain any unusual budget items in your proposal's Budget Narrative section. <>
 F   Occasional token numbers have been added in tan-colored budget entries to prevent distracting "DIV/0!" signals in automatic gray-shaded
     cells elsewhere in the budget. As you overwrite these token entries, these calculations will reflect your budget. <>
 G   While in an automatic gray-shaded cell, you can doublecheck the other cells involved in deriving the calculation by hitting the F2 key or

Line-by-line instructions:
 1 Organizational info, Box 1, Line 1: The organization must be a legal entity with the legal capacity to enter into a grant contract. Typically
   this organization will be a non-profit corporation. If your micro-lending activities are a "project" within a larger legal entity, the latter legal entity
   must be the applicant on line 1. <>
2 Grant Start Date: All grants start in October 2008. <>
3 Audit, Line 9: Please include latest audit with your application. <>
4 Service area, Line 19: List the counties you serve for Core programs with high volume or plans to expand to currently unserved counties or
   areas, be sure to pay special attention to Tab 8 (Counties Served).<>
5 Box 2 Budget, Col G & H: Note that all entries inserted (in tan cells) should be 12-month annualized numbers. Applicants should begin
   inputs leading to overall Total Program Budget (Col. G) first. Then fill in the proposed LB 327 grant award (Col H, lines 31,38,43,49 and 56).
   The LB 327 total (Col H, line 57) should represent your TOTAL request.<>
6 Staffing, Lines 24-31: In addition to staff compensation in Col. E, estimate full- or part-time status of staff in column D as "FTEs" (full-time
   equivalents). Please enter a NUMBER; for example, 1.00=full-time, 0.50=half-time. In column C, provide job title. If your program uses
   consultants, estimate the total number of consultant hours for the 12-month period. If you have more than 4 staff and more than 1 consultant,
   add additional lines (Insert/Row) (double-check the formula in line 31, Col. G).<>
7 Fringe, Line 30: If your organization provides fringe benefits, those costs can be combined with staffing (lines 25-28) or (but not both)
   separately on line 30. <>
8 Total staffing: Line 31, Col. G: When using on-screen, this cell (like all shaded cells in Column G) will automatically total the individual
   entries from columns E. <>
9 Travel, Lines 32-38: Where appropriate, travel items should be estimated as "units" with appropriate "rates" used by your organization (per
   diem), commonly accepted by a state or federal standard (mileage rates), or reasonably estimated (lodging, airfare). Combine and list any
   "Other travel" costs in line 37. Programs may charge program costs to AEO's annual conference, and NEF trainings in addition to travel
   costs for delivery of services. If a program would like to attend other trainings they must seek NEF approval for use of LB327 funds in
10 Equipment, Lines 39-43: Using LB 327 grant funds for long-term equipment costs is available for core program funding only. Explain in
   budget narrative any item over $500. <>
11 Supplies, Lines 44-49: Estimate annual amount of indicated items. Indicate additional items in Line 48, Column C-D, and combined costs of
   such "other" supplies in Line 48, Column E. <>
12 Other, Lines 50-56: Estimate annual phone and space costs as provided. Please list (in Line 54, Col. C-D) and any additional program costs
   (not already listed above.) <>

13 Indirect rate, Line 55: If your organization uses an indrect rate to proportion certain overhead costs, please enter the dollar amount in Cell E-
   55. The indirect rate will be automatically calculated for you in cell D-55.The maximum Indirect Rate allowed is 15%. <>
14 TOTALS, Line 57: Col. G will automatically add projected cost of your entire microenterprise program (lending and training). Col. H will
   automatically total your request under this proposal (see Inst # 5). This amount should be your entire LB 327 amount.
15 Other Funds (Col I, Line 57), Box 3 and Match: Cell I-58 will automatically fill in after you complete Box 3. NOTE that "funds from other
   sources" is NOT the same thing as "available match." In 2008-2009, the required non-state match is 25%. As a result, many programs will
   have significantly more eligible funds than the required 25%. In Box 3 you provide an estimate of all the available funds which support your
   total microenterprise budget shown in Box 2 Col. G. If you want to designate a particular source of funds as your 25%, do so at Line 71. <>

16 Unmet need, Col. I, Line 58: "Unmet need" is a fact of life for most non-profit programs. It does not disqualify an applicant so long as the
   applicant has a plan for raising those funds. If your program has an unmet need over 15% of the total budget, please explain how you plan to
   meet that unmet need in the budget narrative and how a persisting unmet need would impact your program's capacity to perform the
   proposed plan. If Cell I-58 shows a negative "unmet need," something is wrong. It could mean that you asked for a larger grant than
   you need, and you should reduce your grant amount. Note that Col I "other" sources does NOT include the proposed LB 327 grant. <>

                                                                    TAB 2                                                                  3 of 12

17 ALERT: Please review the amount of your total request (cell H-57) and make sure that you believe it to be realistic and justified
    under the goals of LB 327.
18 Box 3, Other Sources (Lines 59-71): This table sorts out "other" funds in two ways: (1) by award decision-maker of other funds ( who made
   the decision, rather than where the funds came from) (lines 61-67); and (2) by status of funds (cols. F-H). "Rec'd (in-hand)" funds (Col.F)
   means any award transmittal you have received between Jan 1,2007 and now that will be available for Oct 2008- Sept 2009. "Committed"
   (Col.G) means any written commitment of funds, not yet received, during that same period. "Pending" funds (Col.H) means any informal
   commitment (no written documentation) of funding which you can reasonably expect to receive prior to September 30, 2009. <>

19 "Total possible" match, Line 68, Col. D: The formula in this cell automatically totals qualifying match, including matches from pending
   sources, but excluding any amount from line 67 (State general funds do not qualify as LB 327 match). <>
20 "Available" qualifying match, Line 69, Col. D: While "pending" non-state funding qualifies as LB 327 for award purposes, for actual award
   disbursement purposes only available qualifying match funds ("received" or "committed") can be counted. An award based on pending
   qualifying matches will be adjusted to the full amount once documentation is provided that the pending match has, in fact, been "received"
   prior to September 30, 2009. <>
21 Required match: Line 70 is the 25% of the minimum non-state match needed to support your request. Line 71 allows you to specify
   particular funds as your match. <>
22 Box 4, Lines 72-109: All applicants are to complete Box 4<>
23 NOTE: There is no way to gauge the demand for Core II awards. The investment committee has the authority to adjust amounts and may
   ask your organization to submit new, reduced budgets.<>
24 Signature needed: Please have authorized individual sign this application and forward to NEF. Thanks.<>

                                                                   TAB 3 (3 pp)                                                            4 of 12

                                        OPERATING GRANT BUDGET FORM                    (See instructions at tab 2)

       Attachments checklist:
       ________         Copy of 501c3               ________   Most recent audit              ________               Map of service area
       ________         Business Plan               ________   Program Dir. Resume            ________               Evidence rec/com. match
Col:           B                    C                   D            E             F                     G                 H               I
       Box 1: Organizational information                       * = See instructions
 1       * Organization:                                                                              Grant Yr (Oct 08-Sep 09):*       Oct-08
 2       Organizat'n type:    Non-profit (Y/N):                Tax-exmpt?(Y/N)                          Political subdiv'n (Y/N):
 3                Project name (if different from organization name):
 4             Address:                                                   E-mail:
 5            City/town:                                                   State:                                              Zip:
 6               Phone:                                                      Fax:
 7           Person to whom all communications are sent (contact person):
 8                Person with the authority to sign grant agreement:
 9          Month your fiscal year begins:               Please attach your latest available audit.

       Please state the amount of funds you are applying for in each category:
10     1. Core I Program                                              4. Evergreen Loan
11     2. Core II Program                                             5. Loan Plus Grant
12     3. Special Program                                                 (4% of loan)
13                                      Total Grant Request $            -               Evergreen Loan Total $                -

       Funds Received from NEF in past years:
               Grants:                                         Evergreen Loans:
14     2004-2005                                                   Date      Amount                    Date              Amount -
15     2005-2006
16     2006-2007

       Do you anticipate a need for NEF loan capital in the next 12 months? Enter "yes" or "no":

       Which of the following services do you provide? Enter "yes" or "no":
17     Training                            Technical Assistance                               Micro Loans
18     IDA's                               Other (describe)

       If you provide loans, what is the size of your loan pool?                              Total Outstanding Loan Portfolio
       What was the program default rate for July 07-June 08?
19          * Microenterprise service area:
                                  (list counties)

       The following questions relate to MicroTest and CDFI reporting. Please answer to the best of your knowledge.
20                       Program Earned Income ( July 2007 - June 2008)                               $       -    Lending
                                                         From Lending From Training                   $       -    Training
                            Interest Income
                            Client Fees
                            Other: ___________
                         Total Program Income (July 2007 - June 2008)                                 $       -

                             Program Expenses ( July 2007 - June 2008)
                             Salary/Fringe                   Loan Loss Reserve
                             Interest                        All Other Expenses
21                           Total Program Expenses (July 2007 - June 2008)                                          $         -
22                                                                        Program Self-sufficiency ratio                               #DIV/0!
23                           Percent of clients in Low to Moderate Income category, (defined
                             by HUD as 80% of median income for the county)

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                                                                           TAB 3 (3 pp)                                                                 5 of 12

     Sources of Income (July 2006-June 2007).
                              Private                                       Federal                                     State
                     Earned Income $          -                               Local                        State-gen funds                  $         -
                                                                                                                Total Sources of Income Jul 07 - June 08
     Income Source Breakdown
                     Type of Funding 7/07 - 6/08                                                                             Reliability of Funding
         Funding by Source           Grant              Contract                                                    A                    B              C

         Private foundation

       Corporate foundation

          Individual donors

           Federal program

             State program

        Local/City program

                    Total                         $0            $0                                                           $0                $0               $0

     Box 2: Total Budget Expense Categories                               Col. E                 F                 G                    H                I
     * = See instructions                                                                                      12-Month           Use of LB327         From
24   Staffing                   Title or Function        FTE%         Annual Am't ($'s)                        Total Prog         funds (base+         other
25   Staff 1                                                                                                    Budget              supplmt)          sources
26   Staff 2
27   Staff 3
28   Staff 4
29   Consultant
30   Total staff fringe *
31                                                                   Total Staffing > > > > > > >$                            -

32 Travel                         No. of Units*                             Rate          Ann.Am't (Col CxE)
33 Mileage                                              miles @                 0.585            -
34 Per diem                                             days @                                   -
35 Lodging                                              nights @                                 -
36 Airfare                                             Rd trips @                                -
37 Other travel                                                                                  -
38                                                                     Total Travel > > > > > > >$                            -

39 Equipment *                (Core programs only)                     Annual Amount
43 Explain any item over $500 in budget narrative.                 Total Equipment > > > > > > >$                             -
44 Supplies                                                            Annual Amount
45 Printing
46 Postage
47 Publications/prof. membership
48 Other:
49                                                                   Total Supplies > > > > > > >$                            -
50 Other:                                                              Annual Amount
51 Phone
52 Space
53                                                                                        Double Chk
54 Misc.                                                                                  No more than
55 Indirect *                  No more than 15%         #DIV/0!                           $          -
56                                                                      Total Other > > > > > > >$                            -
57   TOTALS > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >$                                               -                  -                 -
58   UNMET NEED: (Prepare Box 3 first) Line 58 = G57 - (H57 + I57)                                                                Unmet Need:                     -
     NOTE: Col H, Line 57 is request total.                                                                                         Unmet Need %:            #DIV/0!

                                                                                                a5eec5b1-74c6-410a-b5cc-e200652eb355.xls (4/20/2011, 6:56 PM)
                                                                       TAB 3 (3 pp)                                                                    6 of 12

Col:           B                     C                  D               E                F                   G                    H                    I
       Box 3: Other Sources                                   * = See instructions at Tab 2.
59 Other Sources break-out:                       Please categorize the amount from "Provided by Other Sources" (Col. I, Line 57):
60            By award decision-maker:                                          Recv'd (in-hand)*       Committed *           Pending *              Total
61 Private (foundations, indiv. donors)                                                                                                                          -
62 Federal (excl. state, or locally controlled)                                                                                                                  -
63 State (incl. Fed$ block granted to state)                                                                                                                     -
64 Local (incl. Fed$ rec'd from local govt, ie. CDBG-BD)                                                                                                         -
65 Program earned income                          required entry                                                                                                 -
66 Other: ________________________________________                                                                                                               -
67 State (general funds)                                                                                                                                         -
68 Total possible match (excl. State funds)                   -                                -                       -                  -                      -
69 Available match (excl. pending)                            -
70 Required match (25% of line H-57)                          - Line 71 allows you to specify particular funds as your match if you so choose.
71 Designated 25% Match: (optional)                                 SPECIFY:      ___________________________________________________
               B                     C                  D               E                F                   G                    H                    I
72     Box 4: Outcomes
73     A 2000 amendment to LB 327 removed the maximum award size, and instead authorized the investment committee to
74     assure that the distribution of LB 327 grants provides equitable access to the act's benefits by all geographical areas of the
75     state. In order to implement this goal, the investment committee requests two things:
76                         FIRST, make sure the Box 4 numbers below are filled in as completely and accurately as possible for
77                         your program. GO TO TAB 8 AND COMPLETE before continuing. For current LB 327 Awardees,
78                         most of these numbers can be taken directly from your June 2008 quarterly report submitted to NEF.

79                          SECOND, provide a separate section in your narrative proposal (see page 5, #3 of 2008 funding
80                          announcement) where you provide any additional explanation of Box 4 numbers or information that
81                          relates to your program's plans to help achieve equitable access by all areas of the state.
83     (A). Loan & training volume:               (The term "past 12-mo period" refers to July 2007 through June 2008)
84     Micro loan impacts:
85 Enter # of micro loans originated in past 12-mo period (Jul 2007-Jun 2008):
86 Enter estimated # of loans projected for future 12-mo year (Jul 08-Jun 09):                                                            0 Auto calculation
87 Enter estimated # of loans projected for future 12-mo year (Jul 09-June 10):
88 New loans planned for July 08-June 09:                                                                                                 0   (Auto fr.Tab 8)
91     Training/TA impacts: ( Check trainee definition in red triangle.)
92 Enter # of new Training units/TA clients in the past 12-mo period (Jul 2007-Jun 2008):See red triangle
93 Enter estimated # of new trainees projected for future year (Jul 2008 - Jun 2009):See red triangle                                     0 Auto calculation
94 Enter estimated # of new trainees projected for future year (Jul 2009 - Jun 2010):See red triangle
96 New training planned for July 08-June 09:                                                                                              0   (Auto fr.Tab 8)
99 Number of past referrals to other programs for business services (Jul 2007-June 2008)
100 Number of past loan packages in which your organization provided part of the loan funds (Jul 2007-June 2008)
        Dollar amount of loan packages reported on line 100.
101 Number of past loan packages in which you provided t.a. but didn't make a loan (Jul 07-June 08)
        Dollar amount of loan packages you reported on line 101.
102 Number of loans co-oped with another micro program. (Jul 2007-June 2008)
        Dollar amount of co-oped loans from line 102.
103 How many loans did you make over $35,000 (7/07-6/08)?
        Dollar amount of loans reported on line 103.

       Application submitted by: ______________________________________ Date: ______________

                                                                                        a5eec5b1-74c6-410a-b5cc-e200652eb355.xls (4/20/2011, 6:56 PM)
                                                                      TAB 4                                                              7 of 12

                             Community Impact & Activities Chart (2 year projection)
     The Microenterprise Development Act calls for the establishment of a permanent, statewide infrastructure of microlending
     programs. NEF needs to understand programs' long-term plans and strategies for being part of this permanent structure. All
     applicants need to fill in lines 1-19. Some of your entries from Tab 3 show up below (gray-shaded cells). The table below
     asks for your projections of those numbers over the next two years.

        Organization: 0
  Project (if different): #####                                                                  Year begins:           Oct-08

                                                                                E                     F                    G
                                                                            Previous               Year 1               Year 2
** Note: If you filled in Box 4 on Tab 3, lines 1 and 5 on this Tab are   12-mo. Period          Projection           Projection
already filled in. If you have not completed Box 4 on Tab 3, please do    July 07-June 08       Jul 08- Jun 09       Jul 09 - Jun 10
     Microloan, trainee, & jobs impact:                          (New applicants fill in lines 1,3,5,7,9 manually for Cols. F & G)
 1                       **      Number of loans originated (#):                     0                      0                    0
 2                             Change from previous year (%):                                         #DIV/0!              #DIV/0!
 3                               Amount of loans originated ($):
 4                             Change from previous year (%):                                         #DIV/0!              #DIV/0!
 5                                   **Number of trainees (#):                       0                      0                    0
 6                                 Change from previous year (%):                                         #DIV/0!              #DIV/0!
 7                          Jobs created/retained by new loans (#):
 8                                 Change from previous year (%):                                         #DIV/0!              #DIV/0!
 9                            Jobs created/retained by trainees (#):
10                                 Change from previous year (%):                                         #DIV/0!              #DIV/0!

11 Other proposed indicators of community impact:

14 Additional information from Microlending applicants:
15                Total microenterprise program operat'g bdgt ($):                          -                    -
16                  Estimate of budget used for microlending (%):
17                       Estimate of budget used for training (%):                   100%                  100%                 100%
18                           Estimate FTE used for micro lending:
19                               Estimate FTE used for training/ta:

     Instructions for Programs:
 1   Actual results as base: Column E asks for actual results for your program from Jul 07- Jun 08 and serves as a base. For
     most of the current NEF awardees, you have routinely submitted this Col. E information and have it available in your Access
     Database. <>
 2   Links: Column F represents the 12-months starting July 2008 and running through June 2009. The information provided in
     this column should correspond to information in your proposal. Accordingly, the total budget number at Line 15 (Col. F)
     should be the same number provided in your Operating Budget Form (Col G, Line 57) and are linked. <>

 3   Community impact indicators: Lines 1, 3, 5, 7 and 9 are possible indicators of community impact, but other indicators
     might be more important for your program's strategy and target population. If you would like to propose additional or
     substitute impact measures, please indicate on lines 12 and 13 with measurements in Cols E-G. For other harder-to-
     measure impacts & activities, use Tab 5 ("Quarterly Milestones").<>
 4   Lending-to-trainee ratios: Most core microlending programs will also provide training/TA to clients. Please estimate
     proportion of your program which supports lending activities (Line 16) and non-lending training/TA activities (Line 17). Your
     program may not record such information, but we would like to ask you to take your best guess at the lending-to-training mix
     for the last 12-months (2007-08) and project for the next 2-years. Thanks.<>

                                                                          a5eec5b1-74c6-410a-b5cc-e200652eb355.xls (4/20/2011,6:56 PM)
                                                      TAB 5                                                       8 of 12

                                        QUARTERLY MILESTONES

                             Organization: 0
                       Project (if different): 0
                            Year begins: October-08

Fill out Tab 4 ("Community Impact & Activities Chart) first indicating there any appropriate quantifiable
impact & activity measurements. Additional milestones besides those indicated in Tab 4, should be entered
below (no more than 3/quarter). All applicants will provide these additional "milestones."

 1        October-08          through       December-08

 2        January-09          through         March-09

 3          April-09          through          June-09

 4          July-09           through       September-09

                                                          a5eec5b1-74c6-410a-b5cc-e200652eb355.xls, (4/20/2011, 6:56 PM)
                                                                TAB 6                                                           9 of 12

                                INSTRUCTIONS for the Evergreen Loan Application (at Tab 7)

General instructions:         Read "GUIDE" (Tab 1) before starting forms.
 A As indicated in the GUIDE (Tab 1), the on-screen version of this worksheet, like others in this AP12-2008-2009
   Workbook, includes two types of shaded cells. On-screen users should fill in the yellow-colored cells with the light
   border. The gray-shaded dark bordered cells contain formulas and should fill in automatically as data is entered. Hard-
   copy users should fill in all shaded areas (light & dark borders). <>
 B Many of the terms used in this application packet can be found in the packet's "Glossary." <>
 C Any specifically requested explanation on a budget item or any additional explanation you would like to supply should be
   included in your proposal's Budget Narrative section. <>
 D Automatic fill-in: For programs applying for core and special program operating awards (Tab 3), most of the information
   in Box 1 will already be filled in. For applicants, like single community RLFs applying for evergreen loan only, you will
   need to fill in this information. (Disregard any "0's" that appear in the yellow-shaded cells.) <>
 E   Fill in Tab 3 first: If you are not applying for an operating grant, you only need to fill out Tab 3 (Boxes 1-4), Tab 4, Tab
     5, Tab 7 and Tab 8. Fill out Tab 3 first, since entries there will automatically transfer to the loan application form. <>

Line-by-line instructions:
 1 Organizational info, Box 1, Line 1: The organization must be a legal entity with the legal capacity to enter into a loan
    contract. Typically this organization will be a non-profit corporation. If your micro-lending activities are a "project" within
    a larger legal entity, the latter legal entity must be the applicant on line 1. <>
 2   Audit, Line 10: Please include latest audit with your application. <>
 3   Service area, Line 4: For single community revolving funds, name of county(ies) or town(s). For mulit-county programs,
     number and geographic description of counties. For urban programs, names or descriptions of neighborhoods. For
     applicants which have already filled in Tab 3, info should already be entered. If a long list or description, describe in
     budget narrative or include map. <>
 4   Authorized representative, Line 9: This is the name (and title) of the person who has the authority to sign on behalf of
     the legal organization. <>
 5   Evergreen loan amount, Line 14: Single community loan funds are limited to $25,000 (with 1-to-1 match) or $10,000
     (with no match). Otherwise maximum loan is $100,000. <>
 6   Lines 12-19: Much of the information needed to consider an evergreen loan application duplicates info that you may
     have already answered in previous forms of AP12-2008-2009.xls. If you are also applying for operational support, fill in
     those forms first (see Tab 1-GUIDE). If you are only applying for an Evergreen loan (no operating grant application), fill
     in "Community Impact and Activities" (Tab 4) first. Entries made in earlier tabs will automatically transfer to these lines.

 7   First Microloan, Line 23: If you are proposing to use the proceeds of this Evergreen loan for a microlending loan
     product that is different from your previous style of micro lending, please explain the new lending and include any public
     information you have prepared (brochures, policy and procedure statements, etc.) describing this new loan product. <>

 8   Match, Line 34: See Glossary for definition and requirements. NEF normally requires one-to-one match or setaside of
     current lending capital that is dedicated to micro lending along with the Evergreen Loan. If the only match available
     comes from “Leveraged capital” as opposed to in-hand capital, this should be thoroughly explained in the application
     cover letter. <>

 9   Past due loans, Line 37: Check Glossary for NEF’s definition. If your program uses a different definition, please
     explain. <>
10 Loan loss reserves, Line 41: Describe your loss reserve system and policies (provide policy statements if available).
   Many programs simply set aside a loss reserve account that represents a fixed percentage of anticipated losses based
   on past experiences.
     Ideally, loan loss reserves are based on a regular portfolio analysis and grading system of past due loans accompanied
     by an accounting-based accrual reserve. Newer programs with no track record must set aside an amount that
     represents a loss estimate based on type of loan product (uncollateralized or not, etc.), target population, and size of
     loans. Programs adding new loan products will need to conduct a similar analysis as new programs. <>

11 Business Plan: Applicants are required to submit a business plan if they are not a current grantee of NEF.
12 Loan Policies and Procedures: Applicants are required to submit a copy of loan policies and procedures
   for lending these funds.

                                                                      a5eec5b1-74c6-410a-b5cc-e200652eb355.xls (4/20/2011, 6:56 PM)
                                                            TAB 7                                                        10 of 12

                                               Evergreen Loan Application
(See instructions at tab 6)                                                                   (Words in bold italics in Glossary)
Col:        B                 C              D              E               F             G             H                I
   Box 1: Organizational information                  * = See instructions
 1  * Organization: 0                                                                               Qtr begins *:
 2 Organizat'n type:      Non-profit:         0          Tax-exm't:        0                  Political subdiv'n:            0
 3             Project name (if different from organization name):
 4      * Microlending service area: #VALUE!

5          Address: 0                                                      E-mail: 0
6         City/town: 0                                                       State: 0                           Zip: 0
7            Phone: 0                                                         Fax: 0
8                     Person to whom all communications are sent:     0
9        Person (& title) with the authority to sign loan agreement: 0
10      Month your fiscal year begins:                   Please attach your latest available audit.
11 Are all reports to NEF current?                    (Y/N)                                                 .
12 Is there a copy of your loan policies and procedures on file with NEF?                           (Y/N)
13 List previous Evergreen Loans from NEF:            Date                               Amount
   Add additional lines if necessary.

   Box 2: Application information
14 What size Evergreen Loan are you requesting? ($10,000-$100,000; see instructions)
15 No. of Microloans you expect to make (from all sources) during the next 12-mos.?
16 What do you expect the average size of those Microloans to be?
17 Describe the demand for loans in your service area:

18 Does your program provide Training or TA to borrowers?                              If yes, # in last 12 mos?
      If no, please attach an explanation including programs you have linked with to provide these services.
19 Estimated organizational cost for making/delivering Microloans and Training/TA ?
20 Amount of operating budget that is in-hand or firmly committed?
21 * What proportion of Line 19 was for Microlending ?                                         0% (From Tab 3)
22 * What proportion of Line 19 was for non-lending Training/TA='3.Opert''g Form'!C7 ?      100%
   Box 3: Loan Fund History & Match
23 * Date first Microloan ($35,000 or less) was made by your program?                               (mm/yy)
24 How many Microloans did you make in your last fiscal year?
25 Total amount (face value) of those Microloans ? (from line 24)
26 Avg. size of those loans?                           (line 25 divided by line 24)                                     #DIV/0!
27 How many total Microloans have you made since the program started?
28 Total amount (face value) of those Microloans ? (from line 27)
29 Avg. size of those loans?                           (line 28 divided by line 27)                                     #DIV/0!
   List sources of lending capital dedicated to micro business loans (under $35,000):
             Type: (see GLOSSARY)                      Describe source (and, if debt capital, terms of loan agreement):
30              * Total equity capital:
31                * Total debt capital:
32                       Total capital:             -
33                Leveraged capital:                  (do not include "Leveraged capital" in "Total capital")

                                                                    a5eec5b1-74c6-410a-b5cc-e200652eb355.xls 4/20/2011, 6:56 PM
                                                          TAB 7                                                       11 of 12

34 * Match: Amount of "Total Capital" dedicated to microloans and not coming from (1) previous NEF
   loans or (2) appropriations from the State of Nebraska.            (should at least=Evergrn Loan request)
35 Total Outstanding Loan Portfolio: See Glossary.
36 Uncommitted Funds Available to Lend
37 Past due loans: Loan amounts 30 days past due(for current Awardees, see last quarter's Client Rept Form).
      * (if you track past due loans using different standards, please indicate in cover letter)
38 Current percent of Portfolio-at-risk (Delinquency rate) :                                                       #DIV/0!
      (equals Past due loans divided by the Total Outstanding Loan Portfolio; see GLOSSARY)
39 Portfolio-at-risk Historically (Average delinquency rate since beginning of program)
40 Deployment ratio: Total Outstanding Loan Portfolio divided by Total capital.                                    #DIV/0!
41 Loan loss reserves: Funds set aside as cash reserves to protect against future losses.
     * (in the case of peer group borrowing programs, can include the amount of group-maintained local loss reserves)
42 Net charge-off: Amount of loans determined to be a loss or non-recoverable during your
   organization's last fiscal year.
43 Historical net charge-off: Percentage of loans determined to be a loss or non-recoverable since
   your program started lending.

    Attachments:     Current copies of the following documents should be attached if NEF does not have these on file.
                     ____ Loan Policy and Procedures              ____ Audit
                     ____ Business plan                           ____ 501c3
                     ____ Program Director's Resume               ____ Map of Service Area

    Application submitted by: ______________________________________ Date: ______________

                                                                  a5eec5b1-74c6-410a-b5cc-e200652eb355.xls 4/20/2011, 6:56 PM
                                                    TAB 8.Distressed Counties                                                           12 of 12
                                                      TAB 8. Counties Served
                                                     Low-income Target Areas
                 C. Loans (#) D. Trainees (#)       Projections                                       C. Loans (#) D.Trainees (#)        Projections
                 prog. deliv'd   prog. trained    For 7/08 - 6/09                                     prog. deliv'd   prog. trained    For 7/08 - 6/09
     County       7/07-6/08       7/07-6/08      E. Loans   F.Trnees         County                    7/07-6/08       7/07-6/08      E. Loans   F.Trnees
 1   ADAMS                                                             48    JEFFERSON
 2   ANTELOPE                                                          49    JOHNSON
 3   ARTHUR                                                            50    KEITH
 4   BANNER                                                            51    KEARNEY
 5   BLAINE                                                            52    KEYAPAHA
 6   BOONE                                                             53    KIMBALL
 7   BOYD                                                              54    KNOX
 8   BOX BUTTE                                                         55    LANCASTER
 9   BROWN                                                             56    LINCOLN
10   BUFFALO                                                           57    LOGAN
11   BURT                                                              58    LOUP
12   BUTLER                                                            59    MADISON
13   CASS                                                              60    MCPHERSON
14   CEDAR                                                             61    MERRICK
15   CHASE                                                             62    MORRILL
16   CHERRY                                                            63    NANCE
17   CHEYENNE                                                          64    NEMAHA
18   CLAY                                                              65    NUCKOLLS
19   COLFAX                                                            66    OTOE
20   CUMING                                                            67    PAWNEE
21   CUSTER                                                            68    PERKINS
22   DAKOTA                                                            69    PHELPS
23   DAWES                                                             70    PIERCE
24   DAWSON                                                            71    PLATTE
25   DEUEL                                                             72    POLK
26   DIXON                                                             73    RED WILLOW
27   DODGE                                                             74    RICHARDSON
28   DOUGLAS                                                           75    ROCK
29   DUNDY                                                             76    SALINE
30   FRANKLIN                                                          77    SARPY
31   FILLMORE                                                          78    SAUNDERS
32   FRONTIER                                                          79    SCOTTS BLUFF
33   FURNAS                                                            80    SEWARD
34   GAGE                                                              81    SHERIDAN
35   GARDEN                                                            82    SHERMAN
36   GARFIELD                                                          83    SIOUX
37   GOSPER                                                            84    STANTON
38   GRANT                                                             85    THAYER
39   GREELEY                                                           86    THOMAS
40   HALL                                                              87    THURSTON
41   HAMILTON                                                          88    VALLEY
42   HARLAN                                                            89    WASHINGTON
43   HAYES                                                             90    WAYNE
44   HITCHCOCK                                                         91    WEBSTER
45   HOLT                                                              92    WHEELER
46   HOOKER                                                            93    YORK
47   HOWARD                                                                  TOTAL                         0               0             0          0

                                                                            a5eec5b1-74c6-410a-b5cc-e200652eb355.xls, (4/20/2011, 6:56 PM)

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