CDCI Application

OMB Control Number 1505-0223

Application Guidelines for TARP Community Development Capital Initiative

This application is used by certified Community Development Financial Institutions (“CDFIs”) that are federally-insured credit unions regulated by the National Credit Union Administration (“NCUA”) or the appropriate State Supervisory Authority to request participation in the Community Development Capital Initiative (“CDCI”) under the Troubled Asset Relief Program (“TARP”). Through the CDCI, the U.S. Department of the Treasury (“Treasury”) may purchase qualifying assets from CDFI credit unions.

The application must be submitted to the NCUA for the applicant. All inquiries regarding preparation of the application should be directed to the NCUA. The NCUA may request additional information from the applicant.

All applications must be submitted no later than 5pm (EST), April 2, 2010. More detailed information, including submission instructions, can be found online at Treasury’s website http://FinancialStability.gov/ and the NCUA’s website http://www.NCUA.gov/.

The terms of the CDCI are described generally in this application. However, this description is not binding on Treasury and is intended to provide general information only. The actual terms and conditions of the CDCI are contained in documentation that will be available from Treasury online at http://FinancialStability.gov/.

Eligible Institutions

The CDCI is available to credit unions that: (1) are federally insured and chartered under the Federal Credit Union Act or under the laws of any State, the District of Columbia or any territory or possession of the United States; (2) have a low-income designation per 12 C.F.R. 701.34; and (3) are certified CDFIs.

Institutions must consult with the NCUA prior to submitting this application.

Certain Conditions for Participation in the CDCI

To be eligible for the CDCI, the applicant must receive approval from Treasury. In addition, the applicant must agree to certain terms and conditions and make certain representations and warranties described in various agreements that will be prepared by the Treasury and available online at http://FinancialStability.gov/. Failure to agree to all terms and conditions may result in disqualification from the CDCI. A summary term sheet currently is available online at http://FinancialStability.gov/. Detailed investment agreements and associated documentation will be posted soon. Each applicant must obtain and review a copy of these agreements and agree to all of the terms and conditions, including representations and warranties, contained in these agreements.

Among the conditions to participation in the CDCI is the requirement that the applicant and its covered officers and employees must agree to comply with the rules, regulations and guidance of Treasury with respect to executive compensation, transparency, accountability and monitoring, as published and in effect at the time of the investment closing. These rules, regulations and guidance are explained online at http://FinancialStability.gov/.

Assets Purchased by Treasury

For CDFI credit unions, the assets eligible for purchase by Treasury under the CDCI are subordinated debentures that do not constitute a class of stock or represent equity ownership in the issuing credit union and are senior to other capital instruments.

Other Information

The applicant must identify and describe any mergers, acquisitions, or other capital raisings that are currently pending or are under negotiation and the expected consummation date.

Confidentiality

Any applicant desiring confidential treatment of specific portions of the application must submit a request in writing with the application. The request must discuss the justification for the requested treatment. The applicant’s reasons for requesting confidentiality should specifically demonstrate the harm (for example, loss of competitive position, invasion of privacy) that would result from public release of information (See 5 U.S.C. § 552). Information for which confidential treatment is requested should be: (1) specifically identified in the public portion of the application (by reference to the confidential section); (2) separately bound; and (3) labeled “Confidential.” The applicant should follow the same procedure when requesting confidential treatment for the subsequent filing of supplemental information to the application.

The applicant should contact the NCUA for specific instructions regarding requests for confidential treatment. The NCUA will determine whether the information will be treated as confidential and will advise the applicant of any decision to make available to the public information labeled as “Confidential.”

Application for TARP Community Development Capital Initiative

Please complete the following information and follow the submission instructions as described on the Treasury or NCUA websites. In addition to completing the information on this form, please provide a description of any mergers, acquisitions, or other capital raisings that are currently pending or are under negotiation and the expected consummation date (no longer than 1 page).

Institution Name:
Address of Institution:
Primary Contact Name:
Primary Contact Phone Number:
Primary Contact Fax Number:
Primary Contact Email Address:
Secondary Contact Name:
Secondary Contact Phone Number:
Secondary Contact Fax Number:
Secondary Contact Email Address:
Charter Number:
Amount of Investment Requested:
Amount of Institution’s Net Worth:
Amount of Institution’s Outstanding Secondary Capital:
Amount of the Institution’s Total Assets as of its Most Recent Call Report:
Institution has Reviewed the Term Sheets and Related Documentation on Treasury’s Website (Yes/No):
Signature of Chief Executive Officer (or Authorized Designee):
Date of Signature:

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