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

Save and Continue Later

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.

Save and Continue Later

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.
Phone
This field is for validation purposes and should be left unchanged.

Save and Continue Later

Social Enterprise Innovations and Investment Fund Application

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

Name	Address	City	State

Name	Phone	Email