Social Enterprise Innovations and Investment Fund Application

Application to apply for funding for non-profit, mission driven, organizations and individuals in the Nebraska Panhandle who are, or what to use a Social enterprise as a means of attaining sustainability for their organization.

Step 1 of 5 - Your Organization

Your Organization
Organization (or individual's) legal name
Also know as:
If different than above
Legally affiliated organizations if any
Organization Address
Street Address Address Line 2 City State ZIP Code
Organization Phone
Organization Email
Tax ID Number
Tax Status
Example: 501(c)(3)
Year Established
Number of Locations
List of Locations
Name Address City State

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Organization Leadership
Head of your organization:
First Last
Title
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Other key people in organization and their contact information:
Name Phone Email
Upload resume(s) of key individuals here
Drop files here or

Max. file size: 300 MB.
Primary Contact Name
This person will receive all status updates for this application.
First Last
Primary Contact Phone
Primary Contact Email
This address will receive all email updates for this application.

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A clear description of your enterprise's mission.
Clearly define and demonstrate your organizations public benefit mission. What is the problem that you are seeking to address?
Who are the primary beneficiaries of your mission?
How will you evaluate your success?
How will you report these metrics back to the Innovations and Investment fund?

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Information about the enterprise
A complete description of the enterprise and how it will work. Who are your customers? What is your revenue stream?
Complete financial information, including cash flow projections for at least three years of the enterprise's operations.
You may attach additional documents at the end of this page (if necessary).
Formal financial statements for the past two years of the organizations operations, if available.
Drop files here or

Max. file size: 300 MB.
A complete marketing and sales plan demonstrating how you will capture and keep your revenue stream.
You may attach additional documents at the end of this page (if necessary).
Any studies or assessments you have completed, plus any indicators of community or marketplace support and need.
You may attach additional documents at the end of this page (if necessary).
Any support materials that will directly support your request.
You may attach additional documents at the end of this page (if necessary).
The amount of your request, the proposed use of the funds, how will the funds be matched on a 1 to 1 basis, and what type of funding are you seeking?
Example: a loan, a loan guarantee, a "Success infusion", a combination or something else
Additional File Attachments
Attach any additional supporting files for the questions above here.
Drop files here or

Max. file size: 300 MB.

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Sign and Submit Application
I understand that completion and submission of this form is in no way a guarantee of funding. I understand the innovations and investment committee may at their discretion choose to alter the amount of the funding and the form in which the funding will be distributed. Everything that I have stated in this application is true, accurate and complete to the best of my knowledge. I understand the Innovations and Investment committee will retain this application whether or not it is approved. The innovations and investment committee is authorized to verify any information provided in conjunction with this application. The Innovations and investment committee is authorized to check all of the originations or individuals owners’ credit and employment history and to answer questions about its credit experience with all the business owners. The Innovations and Investment Committee is also authorized to inquire about my performance with my bank or other banks the organization or individual has used.
Name
First Last
Title
Date
MM slash DD slash YYYY
Authorized Signature
Draw your signature in the box below
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract): because all or part of the applicant’s income is derived from any public assistance program; or because the applicant has in good faith exercised any right under the consumer credit protection act.
Comments
This field is for validation purposes and should be left unchanged.

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Name	Address	City	State

Name	Phone	Email

Step 1 of 5 - Your Organization

Your Organization

Organization Leadership

A clear description of your enterprise's mission.

Information about the enterprise

Sign and Submit Application