Investment Application – The Beveridge Family Foundation

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Please complete this form to enquire about the eligibility of a potential impact investment from the Beveridge Family Foundation. We appreciate your providing the best answers available at this stage, and understand that aspects of the opportunity will change as discussions continue. For some questions, you may wish to upload documents to supplement your answers on this form. You may upload documents below.

Name*

First Last

Title / Position

Phone*

Email*

Enter Email Confirm Email

Organization*

Which organization seeks the potential impact investment?

Organizations Tax ID Number*

Please enter your EIN.

Website

Address*

Street Address Address Line 2 City State ZIP Code

Project Name*

For what purpose will the funds be used?

Project Description

Briefly describe how the funds would be used.

Target Funding Date

When do you anticipate needing the funds?

Investment Type*

Loan

Equity

Fund

Other

What is the structure for the investment opportunity?

Minimum Loan Term

What is the minimum number of years for the loan term?

Maximum Loan Term

What is the maximum number of years for the loan term?

Investment Return %

What is the target rate of return for the investment?

Impact*

Please describe how this project will measurably and beneficially impact Hampden or Hampshire Counties' community development, economic development, nonprofit development, environmental sustainability or land conservation.

Community Support*

Please describe evidence of strong local support and participation in the project.

Funding Plan*

Please describe how this project will be funded including other institutions being solicited for investments and/or contributions.

Repayment Plan*

Please describe how you intend to repay the investment. For example, provide details of additional sources of income projected with amounts and timeline.

Management Experience*

Please describe the relevant management experience with projects of this type. Include third parties used to supplement existing staff or board experience.

External Conditions*

Please describe the market and economic expectations used in forming you project budget, especially in areas of increased revenue planning.

Additional Information

Financials

Drop files here or

Max. file size: 256 MB.

Please upload the most recent financials for the organization including balance sheet, income and expense, and a pro forma budget for the project to be funded.

Additional Files:

Drop files here or

Max. file size: 256 MB.

Upload additional files in support of this opportunity.

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Name

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