North American Climate Loan Application

Primary Organization ID

Tier B Program Record ID

About You

Salutation

First Name

Last Name

Your Email

Your Phone Number

Your Role in the Organization

Are you the primary contact at your organization for this project?

YesNo

About the Primary Contact

Primary Contact First Name

Primary Contact Last Name

Primary Contact Email

Primary Contact Phone Number

A bit about your organization

To give us a sense of the size and health of your organization, please share the year your organization was founded, how many affiliated/member households you have (if applicable), the combined square footage of all of your buildings, and any other key metrics that you track that convey size and health (e.g. year-over-year growth, increase in attendance, dollars raised per member)

150 words max

What is your organization’s annual budget (not including capital) for the current fiscal year and for each of the two previous fiscal years?

How much in contributions have board members collectively provided your organization annually in the current fiscal year and for each of the two previous fiscal years?

Who is the property owner/decision maker? If it is not your organization (for example you are a renter/tenant on a property owned by another), do you have full approval for this project?

100 words max

Does your organization have its own building?

YesNoOther

Please explain

About Your Project

Project Title

Total Project Cost:

Enter only numbers. Do not enter dollar signs, commas, or periods.

Loan Request Amount:

Enter only numbers. Do not enter dollar signs, commas, or periods.

When do you anticipate completion of your project? (This will determine your loan repayment start date, which is no later than 12 months after loan disbursement.)

Please describe the project and the steps you will take to implement it, including a timeline.

300 words max

For projects that fall into the categories of "going electric" or "energy efficiency," please share details on how your project is using the most efficient product/technology/practice and/or most emissions-reducing option available and explain the project's "green premium" where applicable. Please see the FAQs for more details. For "sourcing clean electricity" projects, enter the size of the solar array in kW.

100 words max

To the best of your ability, please describe the annual cost savings and anticipated payback period (if applicable) of your project. And how did you determine this number?

100 words max

How many metric tons of CO2 or CO2-equivalent emissions will be reduced annually by this project? And how did you determine this number?

100 words max

Are there any local, state, or federal rebates that this project is eligible for? Have you applied or will you apply for them and what is the status? What is the approximate amount of the rebate(s) you hope to receive?

150 words max

If you are hiring an outside contractor to implement the project, what is your process for selecting the contractor, and which firm/individual are you inclined to hire?

150 words max

Briefly describe what other efforts, besides this project, your organization is undertaking to reduce its climate impact. If you already have a Climate Action Plan or have begun to put together your Climate Action Plan, what are some of the most significant elements in it, or likely to be in it?

200 words max

Part of the intent of this loan program is to support climate impact projects that inspire individuals and other organizations in your community to take additional climate action. How do you intend to promote/share information about the project or otherwise engage your community around your organization’s climate work?

200 words max

Assuming your organization receives this loan, will there be sufficient funds to move forward with the project promptly? If not, please explain.

100 words max

If the cost savings of the project are less than the loan repayment, please detail below how you are financing this loan. If possible, list the accounts that you will draw on each year to make the repayments. If the cost savings meet or exceed the loan repayments, please offer details below.

100 words max

Assuming your organization receives this loan, will it be completed in 12 months or less following award notification? If not, please explain.

100 words max

Does your organization have any debt? If so, please describe and include what the debt is for, how much it is, when it’s due, and anything else that would be useful for us to understand about it.

150 words max

Please upload each of the following documents. In the event you do not have a particular document, instead upload an explanation of why it is not available. If you need to upload more than one file to satisfy the requirements, there is an option at the bottom to do so.

Board resolution authorizing loan. See template here.

Please provide financial statements (balance sheet and income statement) from either the prior fiscal year or the year before that; older statements cannot be considered. We strongly prefer financial statements that have been independently audited or reviewed. If your organization does not undergo an audit or review, internally prepared financials (by your accountant, treasurer, or finance staff) are acceptable provided they comply with Generally Accepted Accounting Principles (GAAP). If available, please separate current assets and current liabilities on the balance sheet preparation. Trial balances or other internal software reports are not acceptable. Modified cash-basis financials may be accepted from smaller organizations, contact coalition@adamah.org for pre-approval before applying.

Income statement and balance sheet from two years ago.

Approved budget for the current fiscal year, including updated projections if applicable, and comparison to the prior fiscal year.

If there are any “off book” financial arrangements that exist (e.g. loan from a member that is intended to be forgiven), upload a statement that explains the details of the arrangements.

You may submit a one-page commentary on your current finances when additional clarity would help explain how you are doing, such as an MD&A (Management’s Discussion and Analysis).

Most recent 990, if available.

Your organization's updated P&L statement for the most recent quarter.

Current balance sheet and cash flow statement.

Project budget, note that you are required to use this template.

You are required to submit at least two proposals from individuals or companies proposing to execute your project, including the one you are inclined to hire. Attach proposal 1 here.

You are required to submit at least two proposals from individuals or companies proposing to execute your project, including the one you are inclined to hire. Attach proposal 2 here.

Personal loan guarantor form from one board member and/or major supporter. You can find the form here.

Personal loan guarantor form a second board member and/or major supporter. You can find the form here.

If you are applying for reimbursement for an energy audit (see the FAQs to determine if your energy audit is eligible) attach proof of payment.

If you are applying for reimbursement for an energy audit (see the FAQs to determine if your energy audit is eligible) attach the audit report.

Do you need to upload any more files?

Nope, I'm all set!Yes, I do!

Upload one additional file here. If you need to add more than one, simply select "Add another response" as needed.

Upon approval of your loan request, your organization and your two guarantors will sign the promissory note electronically. You can view the promissory note here. To acknowledge this requirement, please check the box.

Yes, we agree.

Enter the name of the CEO or other most senior staff member of your organization here, indicating they have approved of this application.

By submitting this application, you consent to receive program-related emails. Would you like to be added to the general Adamah newsletter list?

Yes