Baughman/marinelli family opportunity fund

Application for Distribution

Applicant Information
Last Name	First	M.I.	Date of Birth
Street Address	Apartment/Unit #
City	State	ZIP
Phone	E-mail Address
purposes and nature of requested distributions
Education	(Go to Section A on the back for submission requirements)
Amount of Distribution	Grant	$ _______________	Loan	$ _______________	School Sem/Year: _____________________ Date Needed: _____________________
Ongoing Funding Needed?	Expected Graduation Date:
Primary Residence	(Go to Section B on the back for submission requirements)
Refurbish	Purchase First Home Purchase? Y / N (circle)
Amount Needed (Refurbish Only)	Date Needed
Please write a brief description of the refurbishment project.
Earned Income Matching	(Go to Section C on the back for submission requirements)
Explain how funds will be utilized
Business	(Go to Section D on the back for submission requirements)
(Business Applications will be considered only for personal beneficiary LOANS, not GRANTS)
Purchase	Create	Expand	Maintain
Amount Needed	Date Needed
Please write a brief description of your project/program and provide list all background documents included with application.
Section a – Education
Attach/include the following:
Estimate of Costs from institution (previous semester invoice is acceptable).
Transcript of courses completed
If loan application include: 1) A copy of most recent Application for Federal Student Aid (FAFSA) report
2) Information outlining efforts to secure additional financial aid (for example: PLUS loan)
3) A brief written statement of why loan is being requested
4) Loans of $7500 or more require a personal credit report and 2 years tax returns
Section B – Primary Residence
Attach/include the following:
HOME REFURBISH	NEW HOME PURCHASE
Background/Scope of project	HUD-1 closing document
3 independent quotes from reputable contractors on business letterhead
Loans of $7500 or more require the most recent 2 years tax returns and a personal credit report
Section C – earned income matching
Attach/include the following:
Previous Year’s and Current Year’s W-2* – TOTAL W-2 Box 1 INCOME: _________________ Previous Year
PLUS Previous Year’s and Current Year’s Final Paystub – TOTAL W-2 Box 1 INCOME: _________________ Current Year
Only W-2s are required. If both W-2s and Paystubs are submitted, Paystubs will be used; as more tax-free deferrals can be included in grant. *Income from W-2 Box 1 plus additional employee paid tax-free elected deferrals (e.g. 401K) in Box 12 will be included in grant amount.
SECTION D – BUSINESS LOAN
Attach/include the following:
NEW BUSINESS/EXPAND BUSINESS	MAINTAIN/IMPROVE EXISTING BUSINESS
Background on the project/Business Plan for new venture	Background on the project and business need
Profit and Loss statement for the business (Pro-forma for new business)	3 independent quotes from reputable contractors on business letterhead (as applicable)
Revenue/expense projections based on requested investment	The most recent two (2) years Personal and Business tax returns
3 independent quotes from reputable contractors on business letterhead (if applicable)	Personal Credit Report
The most recent two (2) years Personal and Business tax returns
Personal Credit Report
All business loans are personal loans and are the responsibility of beneficiary regardless of the success of the business.
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
Signature	Date