Social Enterprise Innovations and Investment Fund Application Application to apply for funding for non-profit, mission driven, organizations and individuals in the NebraskannPanhandle who are, or what to use a Social enterprise as a means of attaining sustainability for their organization. Step 1 of 5 - Your Organization 20% Your OrganizationOrganization (or individual's) legal nameAlso know as:If different than aboveLegally affiliated organizations if anyOrganization Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Organization PhoneOrganization Email Tax ID NumberTax StatusExample: 501(c)(3)Year EstablishedNumber of LocationsList of LocationsNameAddressCityState Organization LeadershipHead of your organization: First Last TitleAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Other key people in organization and their contact information:NamePhoneEmail Upload resume(s) of key individuals here Drop files here or Primary Contact NameThis person will receive all status updates for this application. First Last Primary Contact PhonePrimary Contact EmailThis address will receive all email updates for this application. 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? Information about the enterpriseA 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 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 elseAdditional File AttachmentsAttach any additional supporting files for the questions above here. Drop files here or Sign and Submit ApplicationI 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 TitleDate Authorized SignatureDraw your signature in the box belowThe 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. NameThis field is for validation purposes and should be left unchanged.
