SBA FORM 1971 Reigious Eligibility Worksheet

Religious Eligibility Worksheet
For all 7(a) and 504 Loan Programs

OMB Control No.: 3245-0348
Expiration Date: XX/XX/XXXX

The purpose of the information requested is to assist the SBA and the Lender/Certified Development Company (CDC) with
determining the eligibility of a loan request from a Small Business Applicant whose business has a religious component. Failure to
submit the information would affect that determination. For non-delegated loans, the completed form must be submitted to SBA with
the loan application. For delegated loans, the Lender or CDC must retain the completed form in its files.
Applicant Business Legal Name
Type of Loan Requested

Requested Loan Amount

___________________________________________
 7(a) loan
 International Trade

 SBA Express
 CAPLine

DBA

_________________________________

 Export Express
 Export Working Capital Program

 504 loan

$___________________

Please detail the use of proceeds below (attach a separate sheet if necessary).

Is the Small Business Applicant and/or its activities connected, associated, or affiliated with a religious organization in any way?

Yes

 No

If “Yes” explain the nature and extent of the relationship (attach a separate sheet if necessary).

Nature of the Religious Component (Please check all that apply)
 Sale of religious books, music, artifacts, gifts, and/or other religious items.
 Religious instruction, counseling, or indoctrination with regard to any items sold (including those listed immediately above).
 Religious instruction, indoctrination, or counseling whether to adults or children (includes use of religious material at day care facilities).
 Religious broadcasting (e.g., religious music, religious programing, including instruction, indoctrination, counseling, and religious services).
 Generation of newspaper, journal, or other religious publications.
 Creation or development of religious materials (e.g. writings, music, artifacts, computer software, religious art, etc.).
 Sale or distribution of religious publications.
 Prayer, mediation, religious worship, religious service or proceeding.
 Provision of reading room or other space to conduct lectures, readings, prayer, worship, meditation, or other activities related to religion.
 Other:__________________________________________________________________________________________________________

Comments or Explanation of the Above (attach separate sheet if necessary)

Describe the quantity or extent of the religious component or activities with regard to the entire business. In this regard, examine both
the actual religious activities (particularly those that involve teaching, instructing, counseling, or indoctrinating) and whether the
religious component pervades or permeates the entire business. (attach separate sheet if necessary)

SBA Form 1971 (05/17)

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Lender/CDC Official:

___________________________________________________
Signature

Print Name and Title:

____________________________________________________

Determination

 Eligible

Date:

______________________

Date:

______________________

 Recommend Not Eligible

Comment or Explanation:

SBA Center/District Counsel:

Type or Print Name:

___________________________________________________
Signature
____________________________________________________

NOTE: According to the Paperwork Reduction Act, you are not required to respond to this collection of information unless it displays
a currently valid OMB Control Number. The estimated burden for completing this form, including time for reviewing instructions,
gathering data needed, and completing and reviewing the form is 15 minutes per response. Comments or questions on the burden
estimates should be sent to U.S. Small Business Administration, Director, Records Management Division, 409 3rd St., SW,
Washington DC 20416, and/or SBA Desk Officer, Office of Management and Budget, New Executive Office Building, Rm. 10202,
Washington DC 20503. PLEASE DO NOT SEND FORMS TO THESE ADDRESSES.

SBA Form 1971 (05/17)

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