Servco Pacific Vehicle Loan Program - Final Application

Servco Pacific Vehicle Loan Program Application Organization and Program Profile Organization Name: ___________________________________________________________________ Administrative Office Address: _________________________________________________________ Select Island City: ______________________________ Island: ____________________ Zip Code: ___________

Service Location Address (if different from above): ________________________________________

Select Island City: ______________________________ Island: ____________________ Zip Code: ___________

EIN: _______________________ Number of Full-time staff: _________

Date of Incorporation: ___________________ Part-time staff: __________

Volunteers: __________

Operating Budget range: Select Range Vehicle you are interested in obtaining: Select Vehicle Mission Statement:

Please attach your current 2019 operating budget, showing your projected or secured annual sources of revenue, and projected annual expenses.

Narrative Questions 1. Provide a brief executive summary of your organization, describing the community you serve and the work that you conduct. (max 1,000 characters = 1/3 page) Please note: This statement will be reviewed by individuals unfamiliar with your work. Please be clear in your response.

2. Describe how you would put to use a vehicle from Servco Pacific to serve your community, including how you will measure the benefits of the vehicle’s use. For example, if you believe the use of vehicle will increase the number of clients served, provide estimates of those numbers or how you will measure the increase. (max 2,000 characters = 1/2 page) Please recall: Servco Pacific staff are looking for responses that describe positive benefit to a community, scale of programming, or enhanced access.

Please attach your current 2019 operating budget, showing your projected or secured annual sources of revenue, and projected annual expenses.