# Application

Please fill out the information below to help CNote get to know your organization!

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#### Provide information for us to contact you:

- First Name*
- Last Name*
- Email*
- Phone
- Your Current Position*

#### A few quick facts about your organization:

- Organization Name*
- EIN*
- Address*
- Address 2
- City*
- State*
  - Alabama
  - Alaska
  - American Samoa
  - Arizona
  - Arkansas
  - California
  - Colorado
  - Connecticut
  - Delaware
  - District of Columbia
  - Florida
  - Georgia
  - Guam
  - Hawaii
  - Idaho
  - Illinois
  - Indiana
  - Iowa
  - Kansas
  - Kentucky
  - Louisiana
  - Maine
  - Maryland
  - Massachusetts
  - Michigan
  - Minnesota
  - Mississippi
  - Missouri
  - Montana
  - Nebraska
  - Nevada
  - New Hampshire
  - New Jersey
  - New Mexico
  - New York
  - North Carolina
  - North Dakota
  - Northern Mariana Islands
  - Ohio
  - Oklahoma
  - Oregon
  - Pennsylvania
  - Puerto Rico
  - Rhode Island
  - South Carolina
  - South Dakota
  - Tennessee
  - Texas
  - U.S. Virgin Islands
  - United States Minor Outlying Islands
  - Utah
  - Vermont
  - Virginia
  - Washington
  - West Virginia
  - Wisconsin
  - Wyoming
- Zipcode*

#### Organization Information

- Inception Date*
- Is the organization a CDFI?*
  - Yes
  - No
- CDFI Certification Date
- Is the organization AERIS rated?*
  - Yes
  - No
- AERIS Rating Date
- AERIS Rating
- Target Market*
- The organization has been lending since (year)?*
- Size of the organization's current loan portfolio?*

#### Organization History

- Major Lines of Business (multiple selection)?*
  - Small Business
  - Microenterprise
  - Communities Facilities
  - Non-profits
  - Consumer
  - Commercial Real Estate
  - Housing
  - Healthy Food Initiatives
  - Other

- Impact Beneficiaries (multiple selection)*
  - Children and Youth
  - Homeless People
  - Immigrants and Refugees
  - LGBTQ
  - Low Income
  - People of Color
  - People with Disabilities
  - Rural
  - Veterans
  - Women
  - Indigenous People
  - Quality Jobs
  - Formerly Incarcerated Individuals

- Development Services (multiple selection)*
  - Business Technical Assistance
  - Credit Counseling
  - Financial Education
  - Homeownership Counseling and Technical Assistance
  - Real Estate Technical Assistance
  - Other

- State Coverage*
- Allocation to Rural (%)
- Define Loan Products, Loan Limits, and Loan Terms*
- Does the organization have a strategic plan?*
  - Yes
  - No
- Date of last strategic plan
- Please provide a brief description of the organization's history and future plans for growth*
- Has the organization ever defaulted on debt?*
  - Yes
  - No
- If yes, please explain
- How do CNote funds support the organization’s capitalization plan?*
- Loan Request Amount*
- What is the organization's preferred timeline to secure funding?*

- UN Goals (multiple selection)*
  - No Poverty
  - Zero Hunger
  - Good Health and Well Being
  - Quality Education
  - Gender Equality
  - Decent Work and Economic Growth
  - Industry, Innovation, and Infrastructure
  - Reduced Inequalities
  - Sustainable Cities and Communities

- Impact Themes (multiple selection)*
  - Financial Inclusion
  - Racial Equality
  - Poverty
  - Homelessness
  - Economic Development and Mobility
  - Gender Equality
  - Affordable Housing
  - Access to Education
  - Mental Health
  - Disability
  - Job Creation
  - Refugee Crisis and Immigration Issues
  - Natural Disaster Recovery
  - Resilient Communities
  - Financial Education
  - Workforce Development & Retraining
  - Community Revitalization
  - Sustainable Agriculture
  - Climate Change
  - Closing The Gap Between Rural And Urban
  - Social and Economic Justice
  - Clean Water and Sanitation
  - Affordable and Clean Energy
  - Responsible Consumption and Production
  - Access to Healthcare
  - Improving the Lives of Underprivileged Children/Families

Submit securely

###### Contact us

- [(510) 431-2422](tel:(510) 431-2422)
- [support@mycnote.com](mailto:support@mycnote.com)