1. family and parenting
2. children
3. daycare and preschool

APPENDIX 8: SAMPLE BUILDING INSPECTION
FORM FOR CHILD CARE
Self-Help Child Care Manual
171
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DCD-0305
Rev. 9/02
Identification #
County
Date of Inspection
BUILDING INSPECTORS INSPECTION FORM
FOR CENTERS IN A RESIDENCE LICENSED FOR
3 TO 12 PRESCHOOLERS (FORMER LARGE DAY CARE HOMES)
NAME OF OPERATION
ADDRESS
TELEPHONE:
CITY
STATE
ZIP
BUILDING INSPECTORS CERTIFICATE
1.
2.
Buildings are required by the licensing agency to meet the Building Code in effect
when an application for licensure is submitted to the regulating agency. Does the building
listed above, to the extent observable, meet the current North Carolina Building Code? Yes
No
If no, list question numbers which do not comply, explain the violation and whether equivalent protection
for the safety of the children is provided:
1)
2)
3)
4)
3.
Are any of the above violations of a life safety concern?
If yes, please list question numbers
4.
In your opinion based on the violations listed above, do you recommend that
the Division of Child Development issue a provisional license to allow time for
correction of the violations?
Yes
No
Yes
No
If yes, how long (30-60-90 days) and for which violations?
(Note: All violations must be corrected before a license can be issued unless a provisional
time period is recommended or equivalent protection is documented.)
5.
Number of rooms approved for occupancy by children?
(Attach sketch of building with rooms identified)
6.
Specify any local zoning restriction:
Signature of Inspector
Jurisdiction
/Date
/Phone:
The Inspectors Certificate and Building Inspection Form are required to be completed in its entirety before the Division
of Child Development can consider the document complete. All questions must be answered; any NO answers must have
a written explanation.
Developed through the cooperation of the Division of Child Development and the Engineering Division of the
Department of Insurance. Please note that the inspection forms do not cover all areas of the Code, but are intended to be
used as a guide for the local inspector. If additional Code items which are not addressed on these forms are found to be
in violation of the Code, please document them on the back of this form.
Prepare in triplicate: Original to Division of Child Development, 1 copy retained by inspector, 1 copy retained
by operator.
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Identification #
County
Date of Inspection
CENTERS IN A RESIDENCE (3 -12 PRESCHOOLERS) BUILDING INSPECTION FORM
1.
Does the building meet the intent of the Building Code for R4 Occupancy?
Yes
No
2.
If an addition has been built for this use, does it meet the Building Code? N/A
(N/A if no new addition)
Yes
No
3.
Do interior wall and ceiling finish materials meet the flame-spread ratings
as required by the Minimum Interior Finish Classification Table, NCBC?
4.
a.
Does each room used for child care purposes have, on that level, access
to two remotely located outside doors?
** IF answer is yes, skip to Question 5.
b.
No
Yes
If 4a is no, answer 4b.
Is an exterior door located in each room used for child care purposes?
**
Yes
Yes
No
If answer is yes, skip to Question 6.
5.
Are all rooms located so as not to have a dead-end distance in excess of 20 feet?
Yes
No
6.
Is the exit door located no more than 48" above grade?
** If answer is no, Is a ramp or pathway to grade provided?
Yes
Yes
No
No
7.
Do all locks on doors require no more than one operation to release the door?
8.
Does this building have a manually operated fire alarm system
(electrically installed system with pull box stations)?
Yes
Are all unoccupied spaces, such as basements, laundry rooms, and
fossil fuel fired furnace rooms provided with approved labeled
automatic smoke and/or heat detectors?
Yes
No
of all windows in the child care room equal to or
greater than 8% of the floor area or is artificial light provided?
Yes
No
Is one-half of the window area openable, or is the space mechanically
ventilated with a minimum of 5 air changes of fresh air per hour?
Yes
No
N/A
Yes
No
HEATING SYSTEMS/MECHANICAL
Is the building free of unvented fuel burning or portable electric space heaters?
13.
Yes
No
Have air conditioning, ventilation, heating, cooking, and other service
equipment been inspected and approved by the appropriate inspectors?
Yes
No
9.
10.
11.
12.
14.
No
Yes_
No
Is the total area
Are all fuel-burning space heaters, fireplaces, and floor furnaces, which
are listed and approved, provided with a protective screen attached
securely to a substantial support in such a way that children will
not be burned?
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Identification #
County
Date of Inspection
15.
Is combustion and ventilation air for boiler or heater rooms taken directly
from and discharged to the outside of the building (N/A if electric
heat is installed)?
N/A
Yes
No
Yes
No
Do the visible and accessible portions of the electrical system comply with applicable
sections of the Electrical Code as determined by the appropriate inspector?
Yes
No
PLUMBING
16.
Do the visible and accessible portions of the plumbing system comply with
applicable sections of the Plumbing Code as determined by the appropriate
inspector?
Date Inspected
ELECTRICAL
17.
Date Inspected
ACCESSIBILITY CODES
18.
Does this building comply with applicable State Building Codes for access/use
by persons with disabilities?
Yes
No
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DCD-0304
Rev. 9/02
Identification #
County
Date of Inspection
BUILDING INSPECTORS INSPECTION FORM FOR CHILD CARE CENTERS
NAME OF OPERATION
ADDRESS
TELEPHONE:
CITY
STATE
ZIP
BUILDING INSPECTORS CERTIFICATE
1.
The areas in the building that are designated as the licensed space are required by the licensing agency
to meet the Building Code in effect when an application for licensure is submitted to the regulating agency.
Does the building listed above, to the extent observable, meet the current North
Carolina Building Code?
Yes
No
2.
If no, list question numbers which do not comply, explain the violation and whether equivalent protection
for the safety of the children is provided:
1)
2)
3)
4)
3
Are any of the above violations of a life safety concern?
Yes
No
Yes
No
If yes, please list question numbers
4.
In your opinion based on the violations listed above, do you recommend that the
Division of Child Development issue a provisional license to allow time for
correction of the violations?
If yes, how long (30-60-90 days) and for which violations?
(Note: All violations must be corrected before a license can be issued unless a provisional time period is
recommended or equivalent protection is documented.)
5.
Number of rooms approved for occupancy by children?
(Attach sketch of building with rooms identified)
6.
Specify any local zoning restriction:
Signature of Inspector
/Date
Jurisdiction
/Phone:
The Inspectors Certificate and Building Inspection Form are required to be completed in its entirety before the Division of Child
Development can consider the document complete. All questions must be answered; any NO answers must have a written
explanation.
This form was developed through the cooperation of the Division of Child Development and the Engineering Division of the Department of
Insurance. Please note that the inspection forms do not cover all areas of the Code, but are intended to be used as a guide for the local inspector.
If additional Code items which are not addressed on these forms are found to be in violation of the Code, please document them on the back of this
form.
Prepare in triplicate: Original to Division of Child Development,
1
copy retained by inspector,
1
copy retained by operator.
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Identification #
County
Date of Inspection
CHILD CARE BUILDING INSPECTION FORM
SECTION A: The following general questions should be answered for BOTH Educational and Institutional type occupancies.
LIGHT & VENTILATION
Is the total area of all windows in the child care room equal to or greater
1.
than 8% of the floor area or is artificial light provided?
Yes
No
Yes
No
Yes
No
Does this building have a manually operated fire alarm system
(electrically installed system with pull box stations)?
Yes
No
Are there at least 2 exits (doors, stairs, smoke proof towers, ramps, or
horizontal exits) remote from each other on each floor or fire section
of the building?
Yes
No
5.
Is the exit capacity adequate?
Yes
No
6.
Are all means of egress adequately illuminated at all times that the building
is occupied?
Yes
No
Are the means of egress identified by readily visible exit signs when the exit
or way to reach it is not immediately obvious to the occupants?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
2.a
b
Is one-half of the window area openable?
(If NO, verify proper mechanical ventilation is provided).
Is space mechanically ventilated as required by ASHRAE 62? (N/A if an existing building).
N/A
FIRE
3.
EXITS
4.
7.
8.
Is emergency power provided for centers with more than 300 occupants
or for centers providing night care as required by the Building Code?
N/A
CORRIDORS AND ACCESS TO EXITS
9.
Are all means of egress unobstructed without passing through a closet,
storage area, kitchen, restroom, or other hazardous space?
10.
Are all exit corridors a minimum 1-hour fire resistance?
(If yes, go to Question 12) (NA applies only if there are no corridors)
11.
If corridors are not 1 hour fire rated, do all child care rooms, spaces, and areas
have a direct level of discharge exit to the outside?
12.
13.
N/A
a. Do all corridors, ramps, and passageways have a minimum 6 feet
clear width in all areas serving as means of egress for capacity of 100 or more?
b. Are all corridors, ramps, and passageways not less than 44" clear width in all
areas serving as means of egress for capacity of less than 100?
Are all dead-end corridors no more than 20 feet in length?
(N/A applies only if no dead-end occurs)
N/A
Page 2 of 5
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Do all doors have a minimum clear opening width of 32" (min. door width of 36")
in the following locations:
a. between occupied rooms and required exits?
b. exit doors leading to the exterior?
Yes
Yes
No
No
15.
Are all doors in the line of exit travel a swinging door (side hinged)?
Yes
No
16.
Do doors to rooms that accommodate more than 50 people swing in the
direction of travel ?
(N/A applies if room accommodates less than 50 people)
Yes
No
Yes
No
N/A
Yes
No
N/A
N/A
Yes
Yes
No
No
Are all stairs with four or more steps provided with proper handrails
and guardrails?
N/A
Yes
No
Are all interior stairs enclosed with 1-hour rated walls and 1-hour
rated "B" labeled doors that are at least 36" wide?
N/A
Yes
No
Are the stair enclosure doors self-closing?
N/A
Yes
No
Yes
No
Yes
No
Do ceilings in habitable rooms have a minimum of 7'-6" clear height?
Yes
No
HEATING SYSTEMS/MECHANICAL
24.
Is the building free of unvented fuel burning or portable electric space heaters?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
14.
17.a
b.
Do all required egress and exit doors have single motion, self-unlocking type
lever, push pad, or panic hardware?
If room accomdates 100 or more people, do all required egress and exit doors
have push pads or panic hardware?
STAIRS (NOTE: If no stairs, interior or exterior, check N/A)
18.a
Are all stairs serving 50 or more occupants at least 44 inches in width?
b
Are all stairs serving less than 50 occupants, at least 36" in width?
19.
20.
21.
N/A
WALLS AND CEILINGS
a. Are all wall and ceiling coverings throughout building non-combustible?
22.
(Use of untreated combustible fiber boards, wood, and other combustible
fiber boards, wood and other combustible fmishes is prohibited).
b. Do interior wall and ceiling fmish materials meet the flame spread ratings
as required by the Minimum Interior Finish Classification Table, NCBC
23.
25.
26.
Have air conditioning, ventilation, heating, cooking, and other service
equipment been inspected and approved by the appropriate inspectors?
Date Inspected
a. Is combustion and ventilation air for boiler or heater rooms taken directly
from and discharged to the outside of the building?
N/A
(N/A if electric heat is installed)
b. If inside air is used for fuel-burning appliance does it meet the requirements of
Chapter 7 of the North Carolina Mechanical Code.
N/A
(N/A if inside air is not used)
PLUMBING
27.
Does the number of waterclosets and lavatories comply with the Plumbing
Code as determined by the appropriate inspector?
(1 watercloset per 15 persons, 1 lavatory per 25 persons)
N/A
Maximum # of persons allowed by plumbing facilities?
Date Inspected
Page 3 of 5
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ELECTRICAL
28.
Do the visible and accessible portions of the electrical system comply with applicable
sections of the Electrical Code as determined by the appropriate inspector?
Date Inspected
MIXED AND MULTI-USE OCCUPANCIES
Are all child care areas separated from adjacent occupancies in accordance with
29.
the requirement of mixed occupancies and the Occupancy Separation
Requirements Table? (N/A if no mixed occupancies)
30.
Do all multi-use areas comply with the most restrictive applicable sections of the
State Building Code for each intended use?
(N/A if no multi-use areas)
(Multi-use is defined as an area which will be used for different functions
at different times and not concurrent. Example: child care to fellowship hall.)
Yes
No
N/A
Yes
N/A
Yes
No
Yes
No
ACCESSIBILITY CODES
31.
Does this building comply with applicable State Building Codes for access/use
by persons with disabilities?
SECTION B: The following questions should be answered only for educational occupancy in addition to the questions answered in
Section A above.
32.
33.
34.
35.
36.
37.
Does the building comply with the Allowable Heights and Building Areas Table
for Educational Occpancy? (If NO, go to Section C).
a. Are all rooms, approved for use by children below grade 2, on the
level of exit discharge? (If NO go to Section C)
b. Are rooms used by children in grades 2 and higher no more than one story above the
level of exit discharge?
Yes
No
Yes
No
Yes
No
a. Do rooms used by children who are less than 2 1/2 years have a direct exit to the outside?
(N/A applies only if center does not serve children under 2 'A yrs)
N/A
Yes
b. Do rooms used by childen under 2 V2 years qualify as alcoves to adjacent spaces with
direct exit to the outside?
Yes
c. If the square footage of the child care area is >20,000 square feet, do all rooms
for all children have direct exits? (N/A if sq. footage is < 20,000)
N/A
Yes
(If NO to both a and b or c, go to Section C)
No
Are all rooms approved for use by children provided with an operable
window which complies with Special Exit Requirements for Educational Occupancy?
(N/A if direct exit to outside)
Yes
No
Is the most remote point in every room occupied by children, including
dining room, not more than 200 feet from the nearest exterior exit ?
(non- sprinklered building)
Yes
No
Are smoke detectors provided in the corridors in accordance with
Automatic Fire Detection and NFPA72 for child care use?
Yes
No
No
No
SECTION C: The following questions should be answered only for institutional occupancy in addition to the questions answered in
Section A above.
38.
Does the building comply with the Allowable Heights and Building Areas Table
for Institutional Occupancy?
Yes
No
Page 4 of 5
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SECTION C cont.:
Are smoke detectors provided in the corridors in accordance with Automatic
39.
Fire Detection and NFPA72?
40.
41.
42.
Yes
No
Does the building provide protection from hazardous areas as required by
Special Institutional Occupancies, Group I Unrestrained Occupancies, Protection
from Hazardous Areas?
Yes
No
Does the building have an approved automatic sprinkler system in accordance with Special
Institutional Occupancies Group I Unrestrained Occupancies?
Yes
No
Yes
No
Is the most remote point in every room occupied by children, including the dining room,
not more than 200 feet from the nearest exterior exit?
Page
5
of 5
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APPENDIX 9: SAMPLE SELF-HELP CHILD CARE
LOAN PACKET
180
Self-Help Child Care Manual
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SELF
HELP
SELF "-NNHELp
CREATING OWNERSHIP AND ECONOMIC OPPORTUNITY
CREATING OWNERSHIP
AND ECONOMIC OPPORTUNITY
A SPECIAL LOAN PROGRAM FOR
COMMUNITY
FACILITIES FUND
CHILD CARE PROVIDERS
Self-Help administers a loan fund created by the NC
Division of Child Development to help you:
started.
Expand.
Get
Buy indoor or outdoor equipment.
Buy vehicles to transport children.
Upgrade your building.
Improve your program's quality.
Thanks to State funds, these loans have:
below-market, fixed-interest rate of 5 percent.
Minimal fees, charged only for approved loans.
No minimum /maximum loan size.
A
WHO'S ELIGIBLE FOR THESE SPECIAL LOANS?
Anyone in North Carolina who runs or wants to run
that serves
or is willing to serve subsidized children. This includes
family child care homes, centers (for-profit and nonprofit),
Head Start agencies and church-based programs.
a registered or licensed child care program
ARE THERE ANY RESTRICTIONS?
Yes. You cannot receive one of these loans if you
already operate more than three for-profit child care
centers. Also, monies from this special State loan fund
cannot be used to buy or construct a building.
Fortunately, Self-Help has other loan programs
which can be used to purchase or construct a building,
thus allowing us to serve all of your needs.
Lending to nonprofits, child care and
supportive homing providers, and other
human services organizations
HOV DO
I
FIND OUT MORE?
Call Self-Help toll-free at 1-800-476-7428.
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SELF -=`, HELP
Dear Child Care Applicant:
Thank you for contacting Self-Help concerning a child care loan and
requesting this package. As an innovative nonprofit lender in the state of North
Carolina, it is our goal to try to provide financing that best meets your needs.
Please refer to the enclosed brochure or check our web site (www.self-help.org) to
learn more about our products and us.
Use this application if you are applying for a Child Care Loan. The
enclosed pink CHILD CARE LOAN APPLICATION CHECKLIST is
designed to make completing your Self-Help loan package an easy process. You
will also find the appropriate forms for completing your loan package. Simply
follow the instructions on the top of each form and provide all additional materials
required. Please note that some of the items requested are not forms in this
package (personal and business tax returns, internal financial statements, résumés
of key management, and plans and bids/estimates from contractors for renovation/
construction projects). If you prefer to complete the Child Care Cash Flow
Statement on the computer, you can download the form in Microsoft Excel on our
web site.
The business card of the loan officer you will be working with is included in
this package. Please send your completed loan application to this person at the
address listed on the business card. Don't forget to sign all documents (especially
the Personal Financial Statement, Commercial Loan Application, and your tax
returns). We retain all application materials sent to us, so make sure you have
copies for yourself. If you have any questions about this package, any of the
forms, or this process, please feel free to contact the Loan Officer listed on the
business card.
Self-Help is one of the leading child care lenders in the country. Included in
this packet is the document entitled Helpful Hints for Child Care Providers, which
offers tips and resources that could assist you in managing your child care
program. If you are interested in receiving additional materials from Self-Help,
use the publication order form found at the end of this packet.
Again, thank you for contacting us. We look forward to working with you
on your application.
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SELF
HELP
HELPFUL HINTS FOR CHILD CARE PROVIDERS
We believe these hints will be useful for both persons planning to start a child care program and
experienced child care professionals. The first section offers some tips for starting-up or expanding a child
care whether at home or in a center and for saving money and enhancing program quality. The second
section provides a list of resources, usually free, that are available to assist child care providers with
curriculum and business planning concerns. We are grateful to many child care providers and members of
the broader child care community for these ideas.
-
-
BUSINESS TIPS
Call Self-Help or check our web site www.self-help.orq: Our web site provides information for
free download. Topics include: pros and cons of nonprofit versus for-profit, historic tax credits, and cash
flow spreadsheets designed specifically for nonprofits, child care, and charter schools.
Market area conditions: Key market factors that you should be aware of include the number of existing
child care programs in the area, the capacity of these programs, the rates they charge, and the vacancy rates
and/or waiting lists at the programs. Your local child care resource and referral agency may be able to help
you obtain this information. The accessibility of your location for commuting parents is also key, as are
local employment and residential growth trends. Check your library or Chamber of Commerce for
information on growth trends.
Income targeting & subsidy programs: You also need to understand the market well enough to
decide whether you will be targeting low-income, middle-income and/or affluent families. This decision
will affect how much you can charge and whether or not you participate in the various child care subsidy
and food programs. Under the star-rated license system, the more stars you have, the higher your
reimbursement rate.
Caring for infants: Providing infant care can be a good business move. Frequently, market area demand
is highest for infant care and you can charge a premium for such care. In addition, parents may keep their
children with the same provider as they advance through the preschool years. On the downside, however,
infant care is labor intensive.
Start-up timing: It is best to start in August/September or January, months when there are breaks in the
school year. Parents are more likely to make changes in care arrangements after vacation breaks.
Food: Contracting out food service preparation during the start-up phase can save you the equipment
costs associated with furnishing a kitchen. This step will also save the cost of hiring a cook and free you
from overseeing meal planning and grocery shopping. While these savings are real, you will have to
carefully manage the contract with the caterer. Consider participating in the Child and Adult Care Food
Program. If your program qualifies, this national program will reimburse you for your food expenses, and
thus add to your revenues. A training component is also part of the food program. If you run a child care
home, contact your local Resource and Referral Agency or state child care consultant to find out how to
apply. If you run a center, contact the state's Special Nutrition Program at (919) 715-1923. Food banks are
another source to use to save on food costs. For centers that are nonprofit (501(c)3) and serve 60% needy
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children (low income or special needs), food can be bought at a highly reduced rate of 14 cents per pound.
There is a small membership fee for those who qualify. Call the statewide office in Raleigh (919) 8750707 to find out the food bank that serves your county.
Economies of scale: Potential providers who are considering opening a child care center should be
aware of the effect of economies of scale. Large centers have more flexibility to move teachers and
students around to adapt to both the staff:child ratios and teacher breaks. Small centers can be successful,
but they have less flexibility to take advantage of economies of scale.
Working capital: All start-ups should have a minimum of three months of working capital (cash
available to fill in the gap between revenue and expenses). Programs that will not open in
August/September or January should have more working capital available.
Revenue projections: Providers should never project being more than 90% full. Projecting being full
(90%) in less than six months is unrealistic. In fact, one expert believes it usually takes at least 24 months
to become full. You might want to consider requiring parents to sign a payment agreement upon enrolling
their child. This can help you manage problems regarding late payment and no payment. The agreement
might require parents to give two weeks notice before taking their child out of the program or have them
pay one week's tuition in advance.
Transportation: Providing transportation for parents is a costly service. It may also reduce the level of
parental involvement. On the other hand, it can be used as a recruiting tool and, in the case of after-school
child care, providing transportation for parents may be a necessity. If you choose to offer transportation,
you should build the cost of offering the service into your fee structure.
Break-even analysis: "Break-even" occurs when business revenues equal business expenses, i.e., zero
profit. The break-even concept is important for the start-up provider, because it is what determines the
minimum enrollment necessary to break-even, or more simply, to not operate at a loss! An example can
illustrate this point:
Example: Joy Childress is about to open a child care center. She divides her expenses into fixed and
variable costs. She estimates her fixed costs those she must pay no matter how many children she has
enrolled, such as her salary, utilities, rent/mortgage, insurance, and overhead -- to be $4,000 per month.
Since she is charging $400 per child per month, she must enroll 10 children per month to cover her
fixed costs, i.e. to break-even ($400/month x 10 children = $4,000).
-
She then needs to estimate her variable costs. Variable costs are costs that change with the number of
children served, such as food, supplies, and extra teachers. Let's say that in her initial estimates they
add up to another $8,000 per month. Taking the same $400 per child per month, she would need to add
20 more children ($400/month x 20 children = $8,000).
Thus, combining fixed and variable costs, Joy needs to take in at least 30 children to break-even. Based
on these numbers, she needs to be sure that the space she intends to use will allow her to be licensed as
a medium center. Otherwise, she will be forced to operate at a loss.
Break-even analysis is not an exact science. Instead of adding more children, she could charge higher rates
or she could plan to enroll older children which would require her to hire fewer teachers because of the
staff:child ratios. In other words, a change in one variable affects the others.
Personnel: The largest part of a child care budget is staff. There are several ways to save on personnel:
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1.
2.
3.
4.
Recruit volunteers to help with clerical and administrative work, thus saving the director's time and
the cost of hiring an administrative assistant.
Recruit volunteers to provide assistance to teachers: to allow you, your teachers and teaching
assistants to devote more attention to the children.
See below for information about the T.E.A.C.H and WAGE$TM program.
Contact government agencies to learn about public dollars that pay the salary of those needing job
training and apprenticeship experience in child care settings. Specific programs and contacts
include the Job Training Partnerships Act agency representative at your local community college
and high school, Summer Youth Program representative at the high school, the Vocational
Rehabilitation Agency, Foster Grandparents Program, Jobs Program representative at your county
Department of Social Services, Senior Employment Program or National Caucus for Black Aged
at your Council on Aging, and Displaced Homemaker Program representative at your Council of
Government office.
Be sure to ask the agency representative if salaries for these individuals will be provided and if
some of the members of your own community that you may already know are eligible to receive
pay under the program. Also, be sure to screen all applicants to see if they are able to carry out
these important child care responsibilities. Finally, be sure to offer the job training these people
need and want if they are to become professional care givers.
Donations: Gifts from friends, family and church members of toys, equipment, curtains, rugs, dress-up
clothes, etc. will help save money. Local merchants may also donate furniture, carpet remnants, building
supplies, fences. In return, you can offer to tell parents about the merchants' generosity.
PLANNING RESOURCES
Several state and nonprofit agencies provide technical assistance on child care issues and/or business
planning and management concerns. These services are generally available at little or no cost. Listed
below is information about the services provided by the agency, where the agency is based, their service
area, and how to reach them by phone to get more information.
NC Division of Child Development Child Care Consultants: State Child Care Consultants are
employees of the NC Department of Human Resources Division of Child Development. They serve as
liaisons between the state government and the local providers and are responsible for inspecting, licensing,
monitoring, and supporting the child care facilities in their area. Consultants also provide technical
assistance on child care regulations in workshops, seminars and classes. Each consultant has a specific
geographic territory. To find out who the consultant is for your area call (919) 662-4499.
Resource and Referral Agencies: Resource and referral agencies (R&Rs) maintain up-to-date
information about resources for starting and administering a child care program and can help assess the
need for a new program. R&Rs also link parents to child care and work to improve the quality of child
care in their service areas. Services provided by R&Rs include: maintenance of a database of child care
programs, telephone child care referral, coordination of the food program for providers, training, and
planning for community child care needs. Call 1-800-246-6731 to find contact information for the R&R in
your county.
Smart Start: Smart Start programs use their funding to improve the quality of child care by providing
training opportunities for child care providers and, in some counties, by awarding grants to child care
centers and home day care facilities. Smart start funds also may also be used to subsidize the cost of care
for poor families. Other services that may be offered include heath care screening for children,
transportation, and family resource centers. For additional information regarding Smart Start efforts in your
county, contact the North Carolina Partnership for Children at (919)821-7999.
SELF-HELP - 1-800-476-7428
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Department of Social Services Child Care Coordinators: The states child care subsidy program is
administered on the county level by Department of Social Services (DSS) child care coordinators. In
addition to helping a child care center or home qualify to provide care to subsidized children, the
coordinators can advise providers about child care training opportunities available and how to enroll in the
Child and Adult Food Program. For more information, contact your local county DSS and ask for the day
care services department.
North Carolina Cooperative Extension Service: The extension service is an information and
educational resource that has offices in each county. They offer one-on-one counseling and training
classes on topics useful to child care providers including budgeting, marketing, child development,
curriculum development, discipline, and how to organize your space. For more information, call your local
county Cooperative Extension office and ask to speak with their Human Development Specialist.
Community College Early Childhood Education Programs: Each community college has a
Department of Early Childhood Education (ECE). Classes can be taken towards the Child Development
Associate Credential or an Associate's Degree in Early Childhood Education. These programs are two
ways in which a child care professional can meet the educational qualifications to be a child care teacher or
program administrator. For more information, contact your local community college.
T.E.A.C.H. Early Childhood and the WAGE$Tm Programs: The T.E.A.C.H. aeacher Education
And Compensation Helps) Early Childhood Project provides scholarships to child care workers to
complete course work in early childhood education. Participants receive scholarships to earn a North
Carolina Child Care Credential, an Associate's Degree in Early Childhood Education or a Bachelor's
Degree in Child Development or to become a Model/Mentor Teacher. WAGESTm is a program that offers
education-based salary supplements. Both of these programs are administered by the Child Care Services
Association located in Chapel Hill, NC. Call (919) 967-3272 for more information.
Small Business Counseling: Free business consulting services are sponsored by local community
colleges, four-year colleges, and universities. One-on-one assistance is provided in writing business plans
and proposals, as well as advice on marketing or budgeting plans. These programs also offer workshops
and courses on important business management skills. Small Business Centers (SBCs) provide these
services at the community colleges and Small Business & Technology Development Centers (SBTDCs)
operate the programs through the university system. To locate the SBC in your area, contact your local
community college or call (919)733-7051 and ask for the Small Business Center Network. Call 1-800 -2580862 to find the SBTDC near you.
HINTS FOR NONPROFIT PROGRAMS
Reducing Costs: College and Co. Gift in Kind can be a good source of extremely office, craft, and
school supplies for nonprofits. They sell supplies to nonprofits at 90% off market prices, and have things
from paper clips to computers. They also offer technology consulting and computer seminars. They are
located in Charlotte at 900 Jay St, and can be reached (704) 347-3477.
Fundraising: Scrip-selling has become a major fundraising tool. Scrip is like a gift certificate that
customers use to buy groceries and other things from participating retailers. Scrip servicers, like the
National Scrip Center, arrange the program for you by getting merchants to sell scrip certificates at 2-16%
discount off the face value, and then selling them to customers at face value. Your organization gets the 216% left over. You can contact the National Scrip Center at (800) 538-1222.
SELF-HELP
-
1-800-476-7428
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TRIP
SELF
CHILD CARE LOAN APPLICATION CHECKLIST
order to provide you with the most efficient service, it is important that you send us a complete package. If you have any questions
concerning application forms or materials, feel free to call the Loan Officer whose card is included in this mailing. Send your completed
package to that Loan Officer's attention. When completing your loan package, please follow the column that corresponds with the
loan amount you are requesting. Make a check in the appropriate box after you have completed/included the item in your loan
package. Loan officers may request additional information after receiving your loan application.
En
Please Include These Items With Your
Loan Package
For Staged
Micro loans
$500 to $1,000
For Micro
Loans
$1,000 to $35,000
For Small Business
Loans
$35,000 or More
Signed Commercial Loan Application
(enclosed)
Personal Financial Statement (enclosed)*
Personal Tax Returns-Most Recent 2
Years.*
Business/Organization Tax Returns- Most
Recent 2 Years
Internal or Audited Financial StatementsMost Recent 2 Years
Current Year Internal Financial
Statements within the last 60 days
.
1
Not required
Not required
Not required
Projected Monthly Cash Flow-12 Months
(A form is enclosed as a guide. You do not need to use it as long
as you provide us with similar information.)
Business Notes Payable Schedule
(enclosed)
Resume(s) of Key Management
(Nonprofits should also submit a list of Board Members & their
affiliations)
Business References (Names and phone numbers
of suppliers, customers, and/or consultants)
2
i
s
I
e
Signed Disclosure Statement (enclosed)
Business Plan (only for new child care
providers) (A form is enclosed as a guide. You do not need
Not required
to use it as long as you provide us with similar information.)
Plans and bids/estimates from contractors
for renovation/construction projects
Child Care Loan Questionnaire (enclosed)
Project Budget Form
(A form is enclosed as a guide. You do not need to use it as long
1
I
1
Not required
as you provide us with similar information.)
'Nonprofit organizations may not need to provide personal guarantees for a loan depending on certain credit underwriting criteria. To determine
zpplicable to your organization, please call your Loan Officer.
1.evised 2-01
if this is
U: \Commercial\Application Materials\Community Facilities Inserts\Child Care Loan App. Checklist 2-01.doc
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SELF =HELP
BASIC INFORMATION
COMMERCIAL LOAN APPLICATION
As-Please tell us about your business or organization.
Business or Organization Name
Who referred you to us?
Street Address
City
State
I
County
Federal Tax ID #(if incorporated)
Date Started
Today's Date
Zip Code
Type of Business
Legal Structure (please check one)
II
Corporation
Nonprofit Corporation
C Corporation
S
Legal Partnership
Sole Proprietorship
Contact Person
1
Business Phone (
Number of Employees now
Limited Liability Corporation
Are you thinking about changing your legal structure? Yes
Home Phone (
)
)
1
No
E-mail
How many jobs will this loan create?
Briefly describe your business or organization & what you plan to do with this loan:
PROJECT INFORMATION ASPlease tell us about your project and/or start-up budget.
Uses of Funds
Sources of Funds
Land and/or Building Purchase
$
New Building Construction
$
Building Improvements
$
Machinery and Equipment
$
Inventory
$
Working Capital
$
Other
$
Other
$
Total Project Uses
$
COLLATERAL £Please tell
Loan Requested
$
Owner's Investment
$
Other Funding Sources (specify)
$
Totals should
al
Total Project Sources
$
us about the assets available to secure this loan.
Asset
Value of Asset
Loans on Asset
Property 1
$
$
Property 2
$
$
Inventory
$
$
Equipment
$
$
Accounts Receivables
$
$
Other:(please specify)
$
$
Other:(please specify)
$
s
Address of Asset
Name(s) of Possible Co-Signer(s) for Loan Request:
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Please send this application form and the required attachments to the attention of the Commercial Loan Officer whose
name and address appears on the business card enclosed with this package. If you did not receive a card with your
package, send the information to the office nearest you, as listed below. We suggest that you keep a copy of the materials
you are sending to Self-Help, since we will not be able to return them to you.
SELF-HELP REGIONAL OFFICE LOCATIONS
P.O. Box 3619, Durham, NC 27702
122 N. Elm St., Suite 810, Greensboro, NC 27401
801 Baxter St., Suite 410, Charlotte, NC 28202
34 Wall St., Suite 704, Asheville, NC 28801
101 W. 141 St., Suite 200, Greenville, NC 27834
272 N. Front St., Suite 300, Wilmington, NC 28401
225 Green St., Suite 1010, Fayetteville, NC 28301
Durham:
Greensboro:
Charlotte:
Asheville:
Greenville:
Wilmington:
Fayetteville:
(919) 956-4400
(336) 378-1840
(704) 376-6778
(828) 253-5251
(252) 752-8866
(910) 341-3272
(910) 309-8383
1-800-476-7428
1-800-269-7426
1-800-394-7428
1-800-229-7428
1-800-893-9669
1-877-559-4284
MANAGEMENT INFORMATION AND ACKNOWLEDGMENTS AsPlease read the following and complete the
information below.
The undersigned hereby certifies that the information contained in this application and related materials is true and
correct. The undersigned hereby further certifies that the proceeds of any loan made as a result of this application will be
used for business or organizational purposes only, and will not be used for personal or consumer purposes. The
undersigned hereby affirms that he or she does not discriminate on the basis of race, color, religion, national origin,
gender, marital status, or age. The undersigned hereby acknowledges that (1) no loan officer has authority to commit
Self-Help to any loan without prior approval by Self-Help's credit committee and (2) any loan commitment must be in
writing and signed by an authorized representative of Self-Help. Self-Help is authorized to make all inquiries Self-Help
deems necessary to verify the accuracy of this statement and to determine the creditworthiness of the business or
organization. The undersigned also authorizes Self-Help to answer questions and inquiries from others seeking credit
experience information about the business or organization.
..esEach individual owner of 20%
or more of this business must sign below and fill in the information
requested. (For Nonprofit Organizations: Please provide this information for the Executive Director,
Treasurer, and/or Board Chairperson.)
Name(print)
Name(print)
Name(print)
Address
Address
Address
SSN or TIN
/
/
SSN or TIN
Date of Birth
Date of Birth
% Ownership
% Ownership
Title/Function
Title/Function
Signature
Signature
Date
Date
/
/
SSN or TIN
Date of Birth
/
/
% Ownership
Title/Function
Signature
Date
IMPORTANT: Please refer to the enclosed checklist. Complete all necessary forms and attach additional items
listed on the checklist. Your application CANNOT be processed without inclusion of ALL required materials. If
you have any questions about your package, please call the loan officer indicated on the business card enclosed.
Revised 6/02
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SELF
HELP
As of Date
PERSONAL FINANCIAL STATEMENT
*Joint Financial Statement
Individual Financial Statement
This is a(n)
*(If married, you must submit a joint statement with your spouse.)
qatilAetlilitiormlork(i) eackproprietni, or,(Z)vich limited liartneeirlitkownS zoy. ormore interestand each general partuer,:or(3)eacfistockholderOwning:,,
2-kkoifno:reofiotinestOc-k or Wanly otheeperion:or entityprovidinga guaranty on-die loan.: Name of First Individual
Name of Second Individual
Social Security Number or
Social Security Number or
Taxpayer Identification Number (TIN)
Taxpayer Identification Number (TIN)
Address
Yrs. At Address
Address
Yrs. At Address
City, State, Zip
Birth Date
City, State, Zip
Birth Date
Employer
Yrs. At Employer
Employer
Yrs. At Employer
Home Phone (
)
,
Work Phone
,
Home Phone (
)
(
''"'
ILIABMiTalEbi),
":
,
,,,,,,%.14,.` ...,7,4
mit-ein
$
$
Mortgages on Real Estate
$
$
Unpaid Taxes (Describe in Section 6)
$
Other Liabilities (Describe in Section 6)
$
TOTAL LIABILITIES
S
NET WORTH (Assets minus Liabilities)
$
$
IRA or Other Retirement Account
$
Accounts & Notes Receivables
$
Life Insurance-Cash Surrender Value Only
(Complete in Section 7)
Stocks and Bonds (Describe in Section 4)
Real Estate (Describe in Section 5)
$
Automobile(s)-Present Value
$
Other Assets
$
TOTAL ASSETS
$
'
:
Acct. Type
'S0.04111,1..IostAiiment.I.Oan's;,.,C*-641t, Account's, and Antn
Original
Balance
9,:.
$
***.i.-iiiitzl;'$,9**,917-ikiiiiqa0400i-
Balance
Salary/Wages
Net Investment Income
Real Estate Income
Other Income (Describe below)
$
$
$
$
TOTAL ANNUAL INCOME
$
Other Income: (Alimony, child support, or separate maintenance income need not be revealed if you do not wish
Name and Address of Note holder(s)
-
Wo.c,...;.:*,
Installment and Revolving Credit Accounts
(Describe in Section 3)
Loan on Life Insurance
Savings Accounts(also include in Section 1)
Acct. Number
1...
ilte
neeeS
-1..,sx, r,,,-..,4
$
$
Financial Institution
4.. Z.,4:ixn.,;,_-.,.- t.>
OW,t0
-t-. :-.F,.
)
Accounts Payable
Cash (Complete Section 1)
'3S00.010-41-0-* AcCa.:4*fr
%.,-,-4As4-
Work Phone (
)
-...M.tall_244:Ari2.-
1.
to have it considered as a basis for repaying this obligation.)
Payments :(.14-; attach mootsmast hettlentified
Current
Balance
Monthly
Payment
Part of thisaintementaniiSignedi
How Secured or Endorsed
and Type of Collateral
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Section 4. Stocks Onc1.13ondi (Use attachments if neceisary..Rach
attachment mustie,,identifiedaspart of this statement and-signed.)
.
Number of Shares
Cost
Name of Securities
Market Value
Quotation/Exchange
Date of
Quotation/Exchange
Total Value
$EiCtitiii:5414154"Estite0Ci.rnlia "(List each parcel separately. ifseattachminti if necessary..,Each:attachntent Most.:,beideritified as a part_
"
..- and signed.)
'
Property A
Property B
statement' ,
Property C
Type of Property (residential/commercial)
Title in Name of
Address
Date Purchased
Original Cost
Present Market Value
Name & Address of Mortgage Holder
Mortgage Balance
Amount of Payment per Month
-yairaa'ifieF&VYXS1.64dry,Ofthe-ijtfeS6On":s- eixthelett;469grib
beldia)
Are you a guarantor, co-maker, or endorser for any debt of another?
Are you currently liable on any lease or contract?
Are there any suits or legal actions pending against you?
Are any tax obligations past due?
Are you obligated to pay alimony, child support or separate
maintenance payment?
Have you ever had a judgement recorded against you?
Have you ever filed bankruptcy? If yes, provide date of discharge.
Face Amount of Policy
Name of Person Insured/ Insurance Company
Cash Surrender Value
Loans On Policy
Is Policy Assigned?
am providing this financial statement for the purpose of obtaining or maintaining credit with SELF-HELP on my behalf or on behalf of others whose credit I may endorse, cosign, or
guarantee. I understand that SELF-HELP is relying on the information provided within this statement (including the designations made as to ownership of property) in deciding to
grant or continue credit. I certify that THE INFORMATION PROVIDED IS TRUE AND COMPLETE and that SELF-HELP may consider this statement to be true and correct until a
written notice of a change is given to SELF-HELP. SELF-HELP is authorized to make all inquiries SELF-HELP deems necessary to verifythe accuracy of this statement and to
determine my creditworthiness. I also authorize SELF-HELP to answer questions and inquiries from others seeking credit experience information about me. If this is a joint financial
statement, these representations and warranties are from each of us.
I
I
Revised 6/01
HAVE READ, UNDERSTAND, AND HEREBY MAKE THESE REPRESENTATIONS AND WARRANTIES
Signature
Date
Signature
Date
U: \Commercial \ Application Materials\Personal Financial Statement.doc
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SELF
CHILD CARE LOAN QUESTIONNAIRE
Thank you for your interest in Self-Help's child care loan program. Please fill out this form in addition
to the other loan application materials. If you have any questions, please call the Self-Help loan officer
whose card was enclosed with this mailing.
Name of Child Care Program:
If you currently operate a child care, is the program a (check all that apply)?
Small child care home
Center
Accredited by NAEYC
Number of Stars
Center-in-residence (formerly called large homes)
For-profit
Nonprofit
Accredited by Nat'l. Assoc. for Family Child Care (NAFCC)
Describe the program you plan to operate after receiving this loan, if different from the above (check
all that apply).
Small child care home
Center-in-residence (formerly called large homes)
For-profit
Nonprofit
Accredited by Natl. Assoc. for Family Child Care (NAFCC)
Center
Accredited by NAEYC
Number of Stars
Do you operate more than one center?
Yes
No
Name of your consultant:
If yes, how many?
Consultant's phone number:
Your child care license/registration number:
What rates do/will you charge?
Now
After Loan
Per (week,month) for ages
Per (week,month) for ages
Per (week,month) for ages
Now
After Loan
Number of children for which you are licensed:
Number of children on a typical day:
Of these, how may receive subsidies?
Number of staff (full-time equivalent):
What hours are you open?
Describe your competition by listing other child care providers in your area and their rates.
Child Care Name
Infant Rate
Toddler Rate
3-5 year olds
After-School
(over)
Rev 2-01
U: \Commercial\Application Materials\Community Facilities Inserts\Child Care Questionnaire 24
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Have any disciplinary actions been taken toward you or your child care program within the last
Yes
No
two years?
If yes, please list the action(s) and date(s) they occurred.
Have you ever been convicted of a crime?
yes
no.
If yes, when and why? (Self-Help reserves the right to check your criminal record)
The following two questions may help you qualify for a loan program sponsored by the N.C.
Division of Child Development. These loans offer a fixed rate that is lower than the rates on SelfHelp's standard loans.
1.
This loan would: (check all that apply)
Solve a compliance problem identified by the state consultant, building inspector,
health inspector or fire inspector (please attach copy of written report)
Allow this child care to become registered or to expand
Pay for improvements to make the child care accessible to persons with disabilities
Allow this day care to increase its star rating or to meet NAEYC or NAFCC
standards (please explain how)
Add square footage to a building
2. To be considered for a loan sponsored by the N.C. Division of Child Development, you must
maintain your compliance with the requirements of North Carolina's subsidized care program and
make services available to subsidized children until the loan is fully repaid. Do you agree to these
requirements? (Regardless of your answer, you may still be eligible for a standard Self-Help child
care loan.)
Yes
No
All loan applicants must read this statement and sign below.
I certify that I have the authority to enter into a contract for the center or home named above,
and that all of the information in this application is true to the best of my knowledge. I give my
permission for the Division of Child Development staff to discuss my application with the staff of
Self-Help.
Signature
Rev 2-01
Date
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SELF =HELP
PROJECT BUDGET
Business Name:
Use this form to show which items you hope to cover through a Self-Help loan, which items you already have or
plan to pay for (owner's contribution), and which items you will obtain through other sources of funding. Only
complete the categories that apply to your operation.
YOUR BUDGET:
Source of Money to Pay for the Item
Use
Item
(A)
Cost or
Value'
(B)
Loan from
Self-Help
(C)
Owner's
Contrib.2
)
(D)
(E)
Loan from
Other
other source (grants, etc.)
Purchase of facility (including all transaction
expenses lawyer, title insurance, taxes, etc.)
Construction of facility (see flip side of page)
Rent deposits
Mortgage or rent before program opens
Utility deposits
Utilities before program opens
Security
Outdoor equipment/furniture
Indoor furniture
Office equipment/supplies
Program equipment/supplies
Housekeeping equipment/supplies
Professional support (lawyer, accountant, etc.)
Vehicle(s)
Insurance (hazard, liability, vehicle bonding)
Staff salaries/wages before program opens
-
License/registration fees (if not in "soft" costs)
Continuing education/staff and program dev.
Other (please list):
TOTALS
1.
2.
I
I
Totals for columns B-E should equal the total in column A
In cases where you already own the item or got it through a donation or sweat equity, please enter what you
think it would cost you to buy it. Also enter this amount in the "Owner's Contribution" column.
What you already own or will purchase with your own funds.
U:/Commercial/Application Materials/CFF Project Budget
revised 2-01
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IF FINANCING CONSTRUCTION OF A FACILITY
Please complete each section below and put the total amount under each heading on the
appropriate lines on the flip side of this page. Note that some of these items may be included in
your contractor's total budget. If this is the case, please write "included in construction cost" on
the line for the cost.
Construction "Hard" Costs
Land purchase
Construction/renovation of building
Utility line installation and hook-up
Water and sewer installation and hook-up
Site preparation (grading, tree removal, etc.)
Driveways/parking
Sidewalks/curbs/gutters
Handicapped accessiblity
Fencing
Signs/Outdoor lighting
Pest inspection and treatment
Landscaping
Exterior decor (awnings, paint, etc.)
Total Hard Costs
Value
Construction "Soft" Costs
Architectural and engineering fee(s)
Building permits
Inspection permits/license fees
Impact fees (sewer and water usually)
Construction loan fees & interest
Surveys (land, foundation, site, environmental)
Environmental testing
Environmental remediation
Soils testing
Appraisals
Legal fees
Construction period insurance
(liability and builder's risk)
Construction payment and performance bond
Final cost certification
10% construction contingency reserve
Total Soft Costs
Total Construction Costs
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Budget
revised 2-01
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REVENUES
Beginning cash balance
45
(LOSS)
Self-Help Loan Payments
16. NET PROFIT
END CASH BALANCE
subtract line 42 from line
Total Expenses
43
Other expenses-Enter additional expenses from other side
42
Variable Costs
Teachers
Assistants
Payroll taxes & benefits (variable payroll only)
Food
Fixed Costs
Director's salary
Other non-teaching salary
Payroll taxes & benefits (fixed payroll only)
Telephone
Utilities
Mortgage or rent
EduCation supPiles/equIpment
Insurance (liability, hazard, auto.)
Office supplies/equipment
Advertising
License fees & dues
Transportation
Training
Accounting & legal
Repairs & maintenance
Property taxes
Owner's draw (if not part of director's salary)
Non-Self-Help loan payments
EXPENSES
Self-Help Loan Amount
Cash Available (add lines 6, 16 and 17)
Total Revenues
41
40
39
38
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
113
17
16
15
14
7
,--
r
MODEL CASHFLOW SPREADSHEET FOR CHILD CARE PROGRAMS
ENTER THE MONTH Start Up
IMP
Number of children - 100% private pay
Number of children - with subsidy
Number of children - after school/summer
Number of children - part time (ages 0-5)
Total number of children
SET,,-\,.
Registration fees
a Private pay tuition revenues
9 Child care tuition subsidies
to After school/summer tuition revenues
it Part time tuition revenues (ages 0-5)
12 Food program revenue
13 Other revenue (please specify)
6
5
4
3
2
I
IF
Total
UACommerciallApplication MatedaSChild care cash flow projections (pg. 1).xis
-i
You can download this spreadsheet in Microsoft Excel from vnvmself-help.org
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Month
ENTER ON REVERSE SIDE
TOTAL THIS SIDE AND
EXPENSE
Please List Other Expenses
1-
23-
5-
6-
7-
8-
912-
Total
U:\Commercial\Application Materials\Community Facilities Inserts\Child Care Cash Flow Projections (pg 2).doc
4-
HELP
SELF
Please use this sheet to fill out the revenues section of the CASHFLOW SPREADSHEET and
then return it with your application.
Average Tuition for Private
Pay Children
Average Tuition for All Subsidized
Children
Infants
1)
1)
Toddlers
2)
2)
3-5 years
3)
3)
Average Tuition for Private Pay
Children Ages 0-5*
* Add lines 1,2 & 3 and divide the sum
Average Tuition for Subsidized
Children Ages 0-5*
by 3
Average Tuition for Private
Pay Children
Average Tuition for All Subsidized
Children
After School
Summer
Part-Time
(ages 0-5)
If you provide 2nd or 3rd shift care, please check here:
Average teacher pay rate/hour
# of teachers
Average assistant pay rate/hour
# of assistants
U:\Commercial\Application Materials\Community Facilities Inserts\Child Care cash flow projections (pg. 3).doc
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Revised 6/02
HELP
BUSINESS NOTES PAYABLES
Date:
Business Name:
Original
Amount
Date
Original
Balance
Due
Date
Maturity
Monthly
Payment
Collateral
U:Commercial\Application Materials\General Applications\Business Notes Payable.
Rate
Interest
Please include on this schedule all existing notes and long-term leases of your business, including mortgages,
revolving credit arrangements, factoring agreements, equipment leases and any other type of debt, secured or unsecured.
Creditor
SELF
SETIF
1
ITETAP
Date
Business Plan for
Describe the service/product you will offer. Provide as much detail as possible.
Describe uali lcations and ex erience o mana ement and other em lo ees and an outside ro essional services
[accountants, attorneys, etc.)
Revised 3/02
U: \Commercial\Application Materials\General Application Pages\business plan guide.doc
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Describe the market area market trends and customers ou will service. Describe our advertisin
and customer service.
Who is
I romotions
ricin
your competition? Be specific. What are the advantages of your product or service?
What are your plans for growth or expansion? How does this relate to working capital, equipment and /or your building
(location, size, age, zoning, condition)?
What is your financing plan?
need to borrow.
Please specify how much money you can put towards the project and how much money you
Include additional comments on separate pages.
Revised 3/02
U: \Commercial\Application Materials\General Application Pages\business plan guide.doc
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SELF
HELP
DISCLOSURE OF RIGHT TO REQUEST SPECIFIC
REASONS FOR CREDIT DENIAL
The undersigned Applicant hereby acknowledges that he/she is aware that under the
provisions of the Equal Credit Opportunity Act, he/she has the right to receive a written
statement of the specific reason(s) for the denial if this application for credit is denied. To
obtain the statement, please contact Self-Help, Attention: Commercial Loan Department, 301
West Main Street, Durham, North Carolina 27701 within sixty (60) days from the date of
notification of the credit denial. Self-Help will send the Applicant a written statement of the
reason(s) for the denial within thirty (30) days of receiving the request for the statement.
Applicant
Date:
Please sign above and return the white copy to us with your application materials.
Retain the yellow copy for your files.
301 West Main Street * P.O. Box 3619 * Durham, NC 27702-3619 * (919)956-4400
*
FAX (919) 956-4600
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Application MaterialsZeneral Application Pages\Disclosure Formdoc
U: \Consnercial\Application
APPENDIX 10:
SELF-HELP PUBLICATIONS ORDERING FORM
Self-Help Child Care Manual
203
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HELP
SELF
Creating Ownership and Economic Opportunity
PUBLICATIONS
Reference materials to help your development
organization operate more effectively
Understanding Supportive Housing: A Guide
to Lending to North Carolina Facilities
Business Side of Child Care
A reference manual for child care
advocates and lenders
A
This 130-page manual is designed for technical
assistance providers and lenders wanting to help child
care programs of all sorts (homes, centers, for-profit
and nonprofit) get started and expand. It covers
revenue streams, expenses, model budgets based on
actual child care operations, constructing a new
facility, start-up issues, making loans to child care
providers, regulations in North Carolina and quality
assessment. The original 1995 text was revised and
expanded in February 1999, and a comprehensive
update is scheduled for 2002. $10
This 57-page manual provides in-depth information
about the many types of supportive housing in North
Carolina. Included is a discussion of the criteria used
to evaluate loan applications from supportive housing
providers; details on regulations; revenues and
expenses of each facility type; information about
capital and operating sources; and contact
information for public agencies (regulatory and
funding) and private organizations (trade associations
and technical assistance providers.) $7.50
reference manual for supportive housing
advocates and lenders
Specialized Lending Spreadsheets
-
Other Useful Information on our Web Site:
www.self-help.org.
Specialized spreadsheets available for child care,
nonprofit, and charter schools. Analyze a program's
month-to-month cash flow break-even points, debt
coverage, and key ratios (payroll, occupancy and food
as percentages of revenues.) These are available for
free download on our web site, www.self-help.org.
(Also available on a 3-1/2 inch diskette that requires
Excel v5.0 for $5 each. IBM format only.)
Our web site has a lot of useful information including
information on historic tax credits and for-profit
versus nonprofit organizations.
- - - ORDER FORM
Qty
Name of Item
Business Side of Child Care
Understanding Supportive Housing
Specialized Lending Spreadsheet specify child care, charter school or
nonprofit. (Circle the one(s) you want.)
Price
Return this form with your check payable to:
Center for Community Self-Help. Please allow
4-6 weeks for delivery. (Please print clearly)
Name
Co/Org
State
City
Phone (
ORDER TOTAL
)
Zip
E-Mail
Mail to: Publications, Self-Help
P.O. Box 3619, Durham, NC 27702
Please send information on becoming a depositor in the Self-Help
Credit Union and help create economic opportunity through ownership.
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