Technology and Capital Improvements Grant Application

Credit Union Name

Credit Union Mailing Address

Street Address City State / Province / Region ZIP / Postal Code

Asset Size

CEO Name

CEO Phone Number

CEO Email

Number of employees (full-time and part-time)

Charter Number

Please find your most recent Financial Performance Report (FPR) on NCUA’s website at: http://fpr.ncua.gov/ Choose the option to view a 2-page FPR summary. Input your CU’s charter number and select Ratio Analysis. In the worksheet below, you will provide the ratios taken from your online FPR. Please use the most recent quarter’s information from the report to compete the following ratios.

Net Worth / Total Assets

Delinquent Loans / Total Loans

Net Charge-Offs / Average Loans

Return on Average Assets

Cost of Funds / Avg. Assets

Provision for Loan & Lease Losses / Avg. Assets

Net Operating Exp. / Avg. Assets

Total Loans / Total Assets

Net Income

Grant Category

Technology or Security Upgrades

Capital Improvements

Underserved Outreach

Consulting Services

Purpose of grant:

Amount requested

Total project budget

What is the proposed timeline for the project and anticipated completion date?

Do you plan to move forward with this project if you do not receive the total amount requested?

Please summarize why your credit union is requesting this grant and how this grant will benefit your credit union and/or the community?

Please provide a budget breakdown listing anticipated expenditures and total cost of the project. Also, include all other sources of income (in-kind contributions, volunteer hours donated, etc.).

You may upload supporting documentation to submit with your grant request. Multiple attachments will be accepted.

Drop files here or

Max. file size: 50 MB.

Please note that grant recipients will be required to submit a letter to the Foundation 60 days following the completion of the project outlining how the grant funds were allocated. The Foundation reserves the right to withhold future grant funds in the event the funds are misused.