Please fill out the online application below, or download a Word version of the application to mail in.
Several important documents MUST be e-mailed to Cornerstone following the completion of this application. Please be prepared to forward the following items (this list will be repeated after form submission):
- Evidence of Site Control (Option to purchase or evidence of ownership such as a deed)
- Appraisal (if also required by a bank, submit the same to Cornerstone)
- Members of the Development Team including architect, contractor, and management company, with resumes
- For renovation projects, include detailed project budget
- For renovation projects, include three (3) bids
- For renovation projects, provide a detailed scope of work
- For renovation projects, provide a timeline for completion of the improvements, clearly indicating projected date of occupancy
- Projection - a ten (10) year operating projection including Net Monthly Income (rent, subsidies, etc.) and Expenses (mortgages, utilities, food, insurance, salaries, taxes, replacement reserves, maintenance, management fees, etc.) and Net Operating Income
- Current Financial Statement
- IRS letter indicating 501(c)(3) tax status, as applicable
- Most recent Annual Report
- Articles of Incorporation and Bylaws
- Most recent IRS Form 990 (for non-profits), or most recent corporate tax returns and individual tax returns of principals
- Credit Report
- Certificate of Good Standing
- Support Letters
• No commitment of funds will be made until the project is formally reviewed by Cornerstone’s Project Review Committee and approved by its Executive Committee.
• No funds will be disbursed until execution of documents including a Deed of Trust, Loan and Recoverable Grant Agreement and Note and the receipt of a 3 percent processing fee. Nonprofit organizations will pay a 2 percent fee.
• Non-tax exempt entities please note: The receipt of any grant funds may be taxable to you or your organization and may result in tax liability for the year in which the grant money is received. We recommend that you consult a tax advisor.
PLEASE NOTE: All fields in this form are required. The form will not be processed if all fields are not filled out. If a field is not applicable to your application, please enter N/A.
Date:
Applicant:
Address:
Contact Name:
Phone Number:
Fax:
E-mail:
Project Address:
A. Project Background
1. Project Cost (as detailed in Attachment J, Sources and Uses of Funds)
a. Acquisition Price: $
Closing Costs: $
b. Renovation
Hard Costs (construction): $
Soft Costs (architect, inspections, fees, etc.): $
c. TOTAL PROJECT COST: $
2. Sources of Funds
a. Funds requested from Cornerstone: $
b. Owner equity: $
c. Other Leverage sources of funding: $
1.) Funder:
Amount: $
Terms:
Date Funds will be Available:
Contact person:
Phone number:
1.) Funder:
Amount: $
Terms:
Date Funds will be Available:
Contact person:
Phone number:
d. TOTAL SOURCES OF FUNDS $
3. Site Control
a. Is the property currently owned by applicant? Yes No
If so, indicate date of purchase.
b. Is the property currently under contract? Yes No
If so, what is the anticipated date of settlement?
B. Applicant Background
1. Organizational Description
Please describe your organization, its structure, mission, and history
2. Principals
• Please describe the background and experience of key personnel.
• Please provide a list of Board of Directors, as applicable, with affiliations.
3. Description of Properties
Please describe properties owned, managed, developed or under development within the last five years. Include address, type of building, number of units, number of mental health consumers/tenants, range of rents, and source of subsidies.
4. Other Information
Please provide information about any foreclosures, bankruptcies, evictions, notices of eviction or citations from any source, including housing, licensing, and civil infractions, from the District of Columbia directly or indirectly affecting the Applicant, organization or its principals. In addition, include information about failed projects, adverse publicity and the Applicant’s response.
C. Proposed Project Description
1. Project and Area Description
Please describe the project including number of mental health consumers/tenants that will be served, number of bedrooms and baths, common space, staff space, location, and proximity to area services, i.e., public transportation, grocery stores. Please indicate Ward number.
2. Referral of Residents
Please provide source of referral of mental health consumers.
3. Tenant Relocation
If there are existing tenants in the project, please provide a relocation plan.
4. Renovation
Please describe in general the plans for renovation of the project, if applicable.
The undersigned hereby certifies that the foregoing information is accurate and complete and reflects the true financial and other capacities of the organization:
Date:
Signature:
Title (Executive Officer or Chief Financial Officer):
