Pat Landi Access Fund Application

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Please provide a brief overview of your proposal, including:

- Brief description of the proposal (Is this investment request for a project/program?)

- Purpose and key anticipated outcomes (What are primary reasons for project/program?)

- Individuals or communities served (Please describe who this project or program is assisting? e.g., Minority Business Enterprise, Women Business Enterprise, Small Business, Enterprise, or other Small Business Alliance entity or group.)

- Amount of funding requested (Overview of how funds will be spent for project/program)

Please provide your organization mission statement.

Tell us a brief history of your organization.

Tell us about your current programs and activities.

Please list some top accomplishments of your organization within the last three years (limit 3-5).

Please provide your IRS EIN number.

Please list your Board of Directors/Advisors and/or Governance Entity.

Please list key staff involved with this project.

Please provide a copy of the organization’s most recent Federal Tax Return and Financial Statement.

Please describe how the Alloy investment will be used for the project or program. How will Alloy investment be leveraged with other funding partners?

Please describe the purpose and objectives of your proposal.

Please provide an overview of your proposed timeline.

Please provide your proposed budget.

Please list any partners in this proposal and the partner’s role.

Please describe the desired measurable outcomes and their anticipated timeline.

Please describe how you intend to measure and report on the effectiveness of the proposal.

Please upload/attach your most recent annual report.

Please include any additional information you feel supports your proposal to the Pat Landi Access Fund Investment Committee.

Please state how your organization will promote the investment received from the Pat Landi Access Fund?

Full Name

Phone

Website

Address

Want to get in touch with a specific Alloy employee from Commercial Capital, Economic Development, or Growth Lab?