Grant Reimbursement Extension Request

Community Development Revolving Loan Fund - Loan and Grant Programs, 12 CFR Part 705

Grant Reimbursement Extension Request Form

Extension Request / Reallocation Request

OMB: 3133-0138

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Grant Reimbursement Expiration Date Extension Request Form

This form must be completed by credit unions requesting to extend the expiration date for reimbursement requests for grants awarded from the National Credit Union Administration (NCUA) Community Development Revolving Loan Fund (CDRLF).

Credit unions must complete the following information and email this form to [email protected]. The email subject line should be “Grant Extension Request” and include the commitment number of the award.

The NCUA will respond to the commitment request via email. All extension requests require approval in writing. Typically the NCUA does not extend expiration date for more than 3 months after the original expiration date.

  1. Date of Request:


  1. Credit Union Name:


  1. Charter#:


  1. Initiative:


  1. Commitment #:


  1. Application#:


  1. Authorized Credit Union Contact Name:


  1. Credit Union Contact Email Address:


  1. Credit Union Contact Telephone #:


  1. Authorized Credit Union Contact Signature:


  1. Original Expiration Date:


  1. Requested Expiration Date:




  1. Briefly describe the project the credit union was initially awarded funds for in this application.







  1. Briefly provide the reason(s) the credit union needs an extension to utilize the funds.







File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCharee D Fitts
File Modified0000-00-00
File Created2021-01-21

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