AHEAD Program Application Important AHEAD Program changes effective as of 2013: 1. Effective as of 2013, the AHEAD Program will no longer provide grants for housing projects that would be eligible for subsidy from the Bank s Affordable Housing Program (AHP). NonAHPeligible housing initiatives will still be considered for AHEAD funding. 2. Submission of an AHEAD Program Agreement is no longer required when submitting an AHEAD Application. If your project is selected for an AHEAD Program grant, you will be required to submit the Agreement with original signatures in early September. The Agreement, which details AHEAD Program compliance policies and procedures, is available in the AHEAD section of the Bank s website under the Forms tab. AHEAD Application Instructions 1. The AHEAD Program Application must include original member and project sponsor signatures. 2. Responses should be limited to the space provided in the Application. Attachments should only include the following: A completed AHEAD Program Budget Worksheet. A copy of the project sponsor s most recent IRS certification of nonprofit status 501(c)(3) letter. A roster of the project sponsor s management team and board of directors (if applicable). AHEAD Application Deadline and Mailing Instructions The Bank will accept completed AHEAD Applications between May 10, 2013, and June 10, 2013. Failure to submit any of the documents listed above by the Application deadline will result in the Application being deemed ineligible. All hard copy documents requiring signatures must be submitted with original signatures. The Application, including all attachments, must be received by the Bank no later than 5:00 p.m. on Monday, June 10, 2013. Applications sent after the deadline will not be accepted. The Bank cannot accept Applications via fax or email. Mailing Address Federal Home Loan Bank of San Francisco Community Investment Department Attention: Leena Randhawa Post Office Box 7948 San Francisco, CA 94120 Overnight or Hand Delivery Federal Home Loan Bank of San Francisco Community Investment Department Attention: Leena Randhawa 600 California Street, Suite 300 San Francisco, CA 94108 For more information, contact the Community Investment Department at (415) 6162542, email communityinvestment@fhlbsf.com, or visit fhlbsf.com. FC 2236 (4/13) Page 1 of 5
I. Project Information Project Name Project Address City State ZIP Code Congressional District in which project is located County II. Member Institution Name Contact Person Address City State ZIP Code Email III. Sponsor Information Name Contact Person Telephone Number Address City State ZIP Code Email Website Address Telephone Number Type of nonprofit organization sponsoring the project: 501(c)(3) Housing Authority Other Describe the sponsor s core mission, management structure, and accomplishments. (Limit your response to the space provided.) FC 2236 (4/13) Page 2 of 5
IV. AHEAD Grant Amount Requested (not to exceed $50,000) $ Project Start Date Has this project received an AHEAD grant in a previous year(s)? Yes No If Yes, provide the project name and number and the year and amount of the previously awarded AHEAD grant(s). Project Completion Date Project Name Project Number Year Amount $ Project Name Project Number Year Amount $ V. Project Description Project Type/Primary Purpose or Impact (Check one box only.) Capacity Building Economic Development Entrepreneurial Financial Education Foreclosure Prevention Housing Initiative Job Training Social Services Provide the estimated number of clients expected to be served by this project. Describe the proposed project, its impact on and benefits to the communities it serves, and its goals. (Limit your response to the space provided.) Describe how the project results will be measured/evaluated? (Limit your response to the space provided.) Briefly describe how the grant will be used. (Limit your response to the space provided.) FC 2236 (4/13) Page 3 of 5
Member s financial involvement in the project (Check the applicable box.) AHEAD Grant Other Grant Amount $ Loan Type Amount $ Other Explain Member has no other involvement in this project. Indicate other funding sources that are committed or will be sought to provide ongoing support or expansion of the project. Source Amount Requested? Yes/No Committed? Yes/No Are other organizations materially involved with this project? Yes No If Yes, please list organizations name(s) and how they are involved. Organization Involvement VI. Project Qualifications Indicate whether the following apply to the project by checking Yes or No. Yes No Will the project create or retain jobs? If Yes, estimate the number of jobs to be created or retained. Do at least 51% of the jobs created or retained by the project or activity have annual salaries at or below 100% of AMI in urban areas or 115% of AMI in rural areas? Does the project qualify as a small business under section 3(a) of the Small Business Act (15 U.S.C. 632(a))? Will the project provide services or benefits (e.g., social services, childcare, public works, etc.) to the community? If Yes, provide a brief description of services and/or benefits: Do at least 51% of households who benefit from, or are provided services by, the project or activity have annual incomes at or below 100% of AMI in urban areas or 115% of AMI in rural areas? FC 2236 (4/13) Page 4 of 5
Is the project located within: Yes No An urban neighborhood or community with an average median income at or below 100% of AMI? A rural neighborhood or community with an average median income at or below 115% of AMI? An Indian Area as defined by the Native American Housing Assistance and Self Determination Act? A property eligible for a federal Brownfield tax incentive? A community affected by the closing of a nearby military installation as defined by the Department of Defense? A community affected by the North American Free Trade Agreement (NAFTA) as designated by the Community Adjustment and Investment Act (CAIP)? A federally declared disaster area? A statedeclared disaster area approved by the Federal Housing Finance Agency? An area designated by HUD as an Urban Empowerment Zone? An area designated by HUD as an Urban Enterprise Community? An area designated by HUD as an Urban Champion Community? An area designated by USDA as a Rural Empowerment Zone? An area designated by USDA as a Rural Enterprise Community? An area designated by USDA as a Rural Champion Community? VII. Certifications The member and sponsor certify that the information in this AHEAD Program Application is correct, and that the AHEAD grant shall be used only as set forth in this AHEAD Program Application, as approved by the Bank, and in compliance with the AHEAD Program Agreement and the Bank s AHEAD Program Policies and Procedures, as defined in the AHEAD Program Agreement, as may be amended from time to time. Member Certification Authorized Signature* Name of Authorized Person Authorized Signature* Name of Authorized Person Date Date * Note: This form must be signed on behalf of the member by one or more authorized signers, in accordance with the member s authorizations on file with the Bank. Sponsor Certification Signature Date Name FC 2236 (4/13) Page 5 of 5
AHEAD Project Budget Worksheet Version 1.10 4/22/11 Project Name Organization Name Budget Period Start (one year) Project Income/Sources of Funds AHEAD Grant Government Grants Foundation Grants Corporate Grants Individual Contributions InKind Support Fundraising Organization Income Client Fees Membership Fees Budget Period End TOTAL SOURCES OF INCOME Total Budget AHEAD Anticipated Committed Must = 0 Interest Income Other Other TOTAL INCOME $0 $0 $0 $0 Project Expenses/Uses of Funds Personnel Salaries and Wages Employee Benefits and Taxes Consultants Stipends/Incentives Program Professional Development Equipment Organizational Costs Curriculum Expenses Instructional Supplies Travel Marketing/Advertising Interest Other Other Overhead Rent & Utilities Equipment Supplies and Materials Insurance Telephone Postage and Delivery Other Other TOTAL EXPENSES $0 $0 $0 $0 Excess/(Deficiency)* $0 $0 $0 $0 * Total income should equal total expenses. Please explain any differences in narrative on separate page.