Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

Password must contain the following:

12 Characters
1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character

Thank you for your interest in a potential loan from the New York Shelter Acquisition and Predevelopment Fund. This survey is intended to gather the basic information that will make our first discussion more productive. This survey can be used with respect to a particular shelter or if you are seeking pre-qualification in advance of a particular project.

All the information provided will be held in confidence by SeaChange Capital Partners and its affiliated funds until we receive your permission to share it.

A Word version of the full application is available here.

Please note:

After you press 'Submit', you will be asked to review your completed inquiry. We will not receive a notification for your submission until you click 'Confirm'. While we can view drafts as they are populated and saved, we will not be notified of your inquiry until you have confirmed your finalized submission.
All attachments across the full application cannot collectively exceed 35MB. Please email them to reports@seachangecap.org if they exceed the limit.
Please ensure you click "Save my progress and resume later" at the top of the form periodically, especially if you do not plan to submit it instantly. Your session may time-out ("403 Forbidden" Error) and lose your unsaved progress if the form is kept open unsubmitted for an extended period of time (~30 minutes). We recommend saving after each page/section, and completing long-form responses in a separate document so that your work is not accidentally lost.
Please contact reports@seachangecap.org for any technical difficulties.

Organization Information

Organization Name

Street Address

Apt./Suite/Office

City

State

Zip

Website

EIN

Organization Contact Information

Primary Contact

First Name

Last Name

Title

Phone Number

Use format ###-###-####

Is the Primary Contact also the Executive Director of your organization?

Executive Director

First Name

Last Name

Phone Number

Use format ###-###-####

Please upload a copy of your tax exemption certificate.

Are you seeking a loan at this time or only to be pre-qualified as a potential borrower?

Please confirm that you have read the term sheet for the New York Shelter Acquisition and Predevelopment Fund.

Yes - I have reviewed the term sheet.

Shelter Information

What is the total amount of the loan you are seeking?

Please provide a description of the site including the address (with block and lots), the community board, the City Council District, and the Council Member.

Please describe the proposed shelter including proposed zoning SF, proposed gross SF, population type, and the # of beds/rooms/units.

Please briefly describe the proposed development process including any partners you expect to work with, the expected time frame, etc.

What is the current status of site control?

Please describe the status of your discussions with DHS and attach any relevant documents (Award Letter, etc)

DHS-Related Documentation

Please describe the development team (architect, contractor, management company)?

What is the appraised value of the site?

Please attach the most recent appraisal (if available)

Please describe the current state of the development planning and attach any preliminary development pro-forma including sources and uses, development budget (hard and soft costs) unit distribution, expected rents, construction and permanent financing, and amortization schedule on permanent debt.

Please upload the preliminary proforma (if available)

Please upload any zoning analysis (if available)

Please upload any environmental analysis (Phase 1) (if available)

Please upload any schematic designs (if available)

Organizational Information

Please describe the mission and history of the organization and summarize its current range of activities.

How would you describe your organization's financial health?

In your most recent fiscal year, did your organization show a surplus, deficit, or breakeven?

In this current fiscal year, do you anticipate a surplus, deficit, or breakeven?

Please list your top three (3) private, philanthropic funders with names and amounts for the last fiscal year:

What is your primary banking relationship? (Institution and contact information)

Financial Documentation

Please attach the three most recent audits, the three most recent Form 990s and the organizational budget for the current fiscal year.

Audits

Audit #1

Audit #2

Audit #3

Form 990

Form 990 #1

Form 990 #2

Form 990 #3

Organizational Budget

Budget

Does the organization work with any company that the Executive Director, any member of staff, or any board member directly (or indirectly) has an economic interest in? If so, please describe.

If the organization is the subject of any meaningful litigation or lawsuits, please describe them here.

As part of our vendor pre-qualification process, we would like to speak with three references who have worked closely with your organization during the past three years. Ideally, these will include a private funder, a development partner, and a community representative (elected or otherwise). Please list your suggest references with contact details here. We will not reach out to them without your explicit permission.

Please provide the name and contact information of the Chair of your Board of Directors.

Is there anything else you would like to tell us at this point?

Additional Documentation

Please attach any other materials (up to three) that you would like us to review

Document 1

Document 1: Description

Document 2

Document 2: Description

Document 3

Document 3: Description

Save my progress and resume later | Resume a previously saved form

Contact Information