Form 2018-02 Disability Funds Financial Assistance Application v2

Disability Funds Financial Assistance (DF-FA) Questions:

1. Describe the needs and challenges of individuals with disabilities¹ within the communities you serve, such as, but not limited to, asset development; affordable, accessible, and safe housing; employment opportunities; and access to assistive products and services that support health and community living. (Character count: 3,500)

2. Discuss your strategy for meeting the needs and challenges identified in Question 1 through your financial products, financial services, and development services directly provided to individuals with disabilities and/or organizations that provide services to individuals with disabilities. Describe your outreach strategy for reaching individuals with disabilities and/or organizations that provide services to individuals with disabilities. (Character count: 3,500)

3. In support of the strategy discussed in Question 2, complete the below chart to demonstrate your track record of providing financial products, financial services, and development services to individuals with disabilities and/or organizations that provide services to individuals with disabilities in order to address the needs and challenges of individuals with disabilities. Only include products and services that you have provided for the primary purpose of benefiting individuals with disabilities over the past three years.

Financial Product Name	Financial Product Description (100 Characters)	Historic Fiscal Year 1		Historic Fiscal Year 2		Historic Fiscal Year 3
		$ of Loans Closed to benefit Individuals with Disabilities	# of Individuals with Disabilities Served	$ of Loans Closed to benefit Individuals with Disabilities	# of Individuals with Disabilities Served	$ of Loans Closed to benefit Individuals with Disabilities	# of Individuals with Disabilities Served
Total $ of all loans closed to benefit individuals with disabilities:
Total $ of all loans closed (must match On-Balance Sheet Loans Closed $):							o

Financial Services Name	Financial Services Description (100 characters)	Historic Fiscal Year 1		Historic Fiscal Year 2		Historic Fiscal Year 3
		# of Financial Services Provided	# of Individuals with Disabilities Served	# of Financial Services Provided	# of Individuals with Disabilities Served	# of Financial Services Provided	# of Individuals with Disabilities Served
Total # of all Financial Services provided to benefit individuals with disabilities:
Total # of all Financial Services provided:

Development Services Name	Development Services Description (100 characters)	Historic Fiscal Year 1		Historic Fiscal Year 2		Historic Fiscal Year 3
		# of Dev. Services Provided	# of Individuals with Disabilities Served	# of Dev. Services Provided	# of Individuals with Disabilities Served	# of Dev. Services Provided	# of Individuals with Disabilities Served
Total # of all Development Services provided to benefit individuals with disabilities:
Total # of all Development Services provided:

4. Describe how you will use the requested DF-FA award to increase and/or expand your financial products, financial services, and/or development services that are directly provided to individuals with disabilities and/or organizations that provide services to individuals with disabilities, to address challenges, such as, asset development; affordable, accessible, and safe housing; employment opportunities; and access to assistive products and services that support health and community living. (Character count: 3,500)

5. Describe any formal or informal partnerships you have established or plan to establish for the purposes of: i) accessing and/or referring customers; ii) developing new products and/or services; and/or iii) providing products and/or services to further your support of individuals with disabilities. (Character count: 2,500)

1 For the purposes of DF- FA, a person with a Disability is: a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment, as defined by the American Disabilities Act (ADA) at https://www.ada.gov/cguide.htm.

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