CDCI Application

OMB Control Number 1505
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
Stat Supervisory Authority to request participation in the
Community Development Capital Initiative (“CDCI”) under the Troubled Asset Relief Program
(“TARP”). Through the CDCI,
CDC , the U.S. Department of the Treasury (“Treasury”) may purchase
qualifying assets from CDFI credit unions
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 30, 2010.
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/.
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/
alStability.gov/.
Eligible Institutions
The CDCI is available to credit union
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
ha a low-income
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/.
http://FinancialStability.gov/. Failure to agree to all terms and conditions may result in
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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.”

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OMB Control Number 1505
1505-0223

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.
website In addition to completing the information on this form,
please provide a description of any mergers, acquisitions, or other cap
capital
ital 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:
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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: