ABLE ApplicationABLE ApplicationWelcome to our application for the ABLE program!To qualify for this loan product, you must meet certain requirements and provide various forms of information and documentation. If you have gathered the proper information, this application should take 15-20 minutes to complete. Before starting, please ensure you:Work for or use the services of one of our participating non-profits (see below).Have gathered financial information on your household income, expenses, debt, etc.Have been employed for at least 12 months for an average of at least 30 hours/week (this will be verified with your employer) OR have another form of steady income for the past 12 monthsMake less than 250% of the federal poverty level for your household sizeAre at least 18 years oldHave a Social Security Card (the card cannot state “NOT VALID FOR EMPLOYMENT”)Have a driver's license or valid, government-issued IDCan provide two months of current pay stubs, a profit & loss statement if you own a business, or other proof of incomeCan provide proof of address via a utility statement, cell phone bill, or lease agreement showing your current addressHave $5 to open a bank account at Pyramid Federal Credit Union (they will provide the loan)Can provide contact information for two references who do NOT live in your householdAre willing to set up monthly payments via payroll deduction or auto bill payAgree to complete an 8-part (free) credit Building course facilitated by Catholic Community Services, Pio Decimo Center.Please note that additional information may be requested and that income limits apply.Currently, we are offering this loan to staff or clients of the following non-profits:Community Food Bank of Southern Arizona - StaffImago Dei Middle SchoolOld Pueblo Community Services - StaffPio Decimo Center (Catholic Community Services) - Staff & ClientsPrimavera Foundation - StaffSouthern Arizona AIDS Foundation - StaffSouthern Arizona Land Trust - Staff & ClientsTucson Urban League - StaffYWCA - Staff & ClientsBefore starting, please attest that...* I have read the above requirements and have gathered information to complete my application.With which participating non-profit do you have a relationship?*(If more than one, select the one you are most closely associated with.)Community Food Bank of Southern ArizonaImago Dei Middle SchoolOld Pueblo Community ServicesPio Decimo Center (Catholic Community Services)Southern Arizona AIDS Foundation (SAAF)Southern Arizona Land TRUST (SALT)Primavera FoundationTucson Urban LeagueYWCA of Southern ArizonaI am not associated with any partner nonprofits.What is the nature of your relationship with the non-profit above?*Check all that apply. I am an employee. I am a client. Neither.Please note: This program is generally only being offered to a limited number of clients and other individuals.* I have spoken with someone associated with this program and have permission to apply.If an individual at this non-profit referred you to this program, please provide their name.If you have questions about this application at any point you may contact: Nick at Community Investment Corporation at 520-529-1766 x209. Anne Marie Summons at Pio Decimo at 520-622-2801, x7114.Personal and Contact InfoName* First Middle Last Date of Birth* MM DD YYYYGender*FemaleMaleOtherPrefer not to answerAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about this loan program?Email Would you like to receive information from us about other loan products or services we provide?YesNoPhone*Is this a cell phone number?*YesNoMay we contact you via text message regarding your application?*YesNoAre you married?*YesNoWould you like to list your spouse as a co-applicant for this loan?*(If you live with your spouse and/or share household expenses, please select "Yes." Additionally, listing a spouse may increase your chances of receiving a loan.)YesNoIf you receive a loan through this program, will you use the money to pay off a title loan, payday loan, or other predatory loan?*We define a "predatory" loan as any loan that charges more than 36% interest (APR).YesNoOur max loan amount is $1,000. Please select the option that best describes your situation below.* The amount I owe is less than $1,000. The amount I owe is more than $1,000, but I can come up with additional money to pay off the loan(s) in full. The amount I owe is more than $1,000 and I currently CANNOT come up with additional money to pay off the loan(s) in full.We're sorry, but we currently can only offer this program to individuals who can, with a $1,000 loan from us, pay off their existing loan(s) in full. Please do not proceed with your application unless you have the cash to make up the difference between your existing loan amount and the $1,000 loan we can offer you.If you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.How many people live in your household (including yourself)?*Do NOT count people who live with you but keep their income separate and pay only their share of expenses.Which races / ethnicities live in your household? Check all that apply.*Your answer to this question will not affect the status of your application. White Hispanic or Latino Black or African American Native American or American Indian Asian Hawaiian / Pacific Islander Other Prefer not to answer.Other Races/EthnicitiesDo any veterans live in your household?*Your answer to this question will not affect the status of your application.YesNoPrefer not to answer.If you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Spouse InfoSpouse Name* First Middle Last Spouse's Date of Birth* MM DD YYYYSpouse's Email Spouse's Phone*Is this a cell phone number?*YesNoMay we contact your spouse via text message regarding your application?*YesNoIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.ReferencesPlease provide reference information for two individuals who do NOT live with you. These individuals are only contacted if we are having trouble contacting you, and are not part of the approval process.Reference #1Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Reference #2Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*If you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Household Financial InformationHow many paying jobs do you have?*Please enter a number from 0 to 4.How many paying jobs does your SPOUSE have?*Please enter a number from 0 to 4.Other than you, how many people in your household work and contribute financially? (Enter 0 if none.)*Other than you and your spouse, how many people in your household work and contribute financially? (Enter 0 if none.)*What other forms of income do you / your household have? Please check all that apply.* Social Security Pension/Retirement Government Assistance (e.g. SNAP, TANF, etc.) Investment Income Child Support Alimony Other NONE OF THE ABOVEWhat expenses do you have in your household? Check all that apply.* Food (groceries and eating out) Mortgage / Rent Clothes, household expenses, hygiene, etc. Cable, Phone, Internet Car Payment(s) Other Debt or Loans (credit card debt, student loans, payday or title loans, etc.) Utilities (gas, electric, water) Childcare Child Support Insurance (car, house, etc.) Health Insurance Medical Expenses, Prescription Medicines, etc. Other NONE OF THE ABOVEWhat size loan are you requesting through this program?*Please enter a number from 200 to 1000.Please note the maximum amount is $1,000.With a new loan from this program, how many loans do you plan to pay off?*1234What else, if anything, do you need the loan for? Please explain.*What do you need the loan for?*Please note these loans are "need-based," meaning they should cover a direct expense which can be paid off with a check we provide you. We do not hand out cash.If you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Employer InformationEmployer (#1) InformationPlease list your primary/main job first.Employer Name*Your Job Title*How many hours a week, on average, do you work at this job?*How much do you earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Employer (#2) InformationEmployer Name*Your Job Title*How many hours a week, on average, do you work at this job?*How much do you earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Employer (#3) InformationEmployer Name*Your Job Title*How many hours a week, on average, do you work at this job?*How much do you earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Employer (#4) InformationEmployer Name*Your Job Title*How many hours a week, on average, do you work at this job?*How much do you earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Spouse's Employer InformationPlease provide information on your spouse's employment.Spouse's Employer (#1) InformationPlease provide information on your spouse's employment. List their primary/main job first.Employer Name*Spouse's Job Title*How many hours a week, on average, does your spouse work at this job?*How much does your spouse earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Spouse's Employer (#2) InformationPlease provide information on your spouse's employment.Employer Name*Spouse's Job Title*How many hours a week, on average, does your spouse work at this job?*How much does your spouse earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Spouse's Employer (#3) InformationPlease provide information on your spouse's employment.Employer Name*Spouse's Job Title*How many hours a week, on average, does your spouse work at this job?*How much does your spouse earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Spouse's Employer (#4) InformationPlease provide information on your spouse's employment.Employer Name*Spouse's Job Title*How many hours a week, on average, does your spouse work at this job?*How much does your spouse earn?*Please list the before taxes amount.And how often?*HourlyWeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Earlier you indicated that others in your household work and contribute financially. All together, how much do they earn in wages?*Please give the amount before taxes.And how often do they receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyYour / Your Household's Other Forms of IncomeFor this section, please list the total amounts received for all members of your household. For example, if you and your spouse both receive social security payments, please add them up and list them together.How much do you and your household receive in Social Security payments?*And how often do you receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyHow much do you and your household receive in Pension/Retirement payments?*And how often do you receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyHow much do you and your household receive in Government Assistance payments?*And how often do you receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyHow much do you and your household receive in payments from investments?*And how often do you receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyHow much do you and your household receive in Child Support payments?*And how often do you receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyHow much do you and your household receive in Alimony payments?*And how often do you receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyHow much do you and your household receive in any *other* forms of income not listed above?*And how often do you receive the above amount?*WeeklyBiweekly (every two weeks)Semi-monthly (twice a month)MonthlyAnnuallyIf you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Household ExpensesPlease estimate the expenses for you and your household on a monthly basis.How much does your household pay per month for food (groceries and eating out)?*How much does your household pay per month in mortgage/rent?*How much does your household pay per month for clothes, household expenses, hygiene, etc.?*How much does your household pay per month for cable, phone, and internet?*How much does your household pay per month in car payments?*All together, how much does your household pay per month in debt/loans (e.g. credit card debt, personal/payday loans, auto title loans, student loans, etc.)?*Please list the minimum amount you need to pay each month.How much does your household pay per month in utilities (gas, electric, water)?*How much does your household pay per month in childcare?*How much does your household pay per month in child support?*How much does your household pay per month in insurance (car, house, etc.)?*How much does your household pay per month in health insurance?*How much does your household pay per month in medical expenses, prescription medicines, etc.?*How much does your household pay per month for all other expenses not listed above?*If you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Loan You Plan to Pay OffLoan #1 You Plan to Pay OffWhat company is your loan with?*What is the current/most recent balance on this loan?*What is your minimum regular payment?*And how often do you make these payments?*WeeklyBiweekly (every two weeks)MonthlyIf you know it, please provide the annual interest rate (APR).(If you only know the monthly interest rate, multiply by 12.)Loan #2 You Plan to Pay OffWhat company is your second loan with?*What is the current/most recent balance on this loan?*What is your minimum regular payment?*And how often do you make these payments?*WeeklyBiweekly (every two weeks)MonthlyIf you know it, please provide the annual interest rate (APR).(If you only know the monthly interest rate, multiply by 12.)Loan #3 You Plan to Pay OffWhat company is your third loan with?*What is the current/most recent balance on this loan?*How much do you regularly pay?*And how often do you make these payments?*WeeklyBiweekly (every two weeks)MonthlyIf you know it, please provide the annual interest rate (APR).(If you only know the monthly interest rate, multiply by 12.)Loan #4 You Plan to Pay OffWhat company is your fourth loan with?*What is the current/most recent balance on this loan?*How much do you regularly pay?*And how often do you make these payments?*WeeklyBiweekly (every two weeks)MonthlyIf you know it, please provide the annual interest rate (APR).(If you only know the monthly interest rate, multiply by 12.)If you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.Supporting DocumentationA number of supporting documents are required to participate in this program. Please note that your application will not be reviewed until you have submitted the proper documents.Proof of incomeProof of address (a utility bill, cell phone bill, or rent/lease agreement)Social Security card*Employment Verification (showing date of hire)Driver's License or valid, government ID * Your social security card cannot state "NOT VALID FOR WORK."How would you like to share this information? Please check all that apply.* Secure file upload via this application form Fax Drop off copies in person EmailWhich files would you like to upload? Please check all that apply.* Proof of income (e.g. two months of pay stubs, social security check stubs, etc.) Proof of address (utility bill, cell phone bill, rent/lease agreement) Social Security card(s)* Employment Verification (showing hire date) Driver's license or valid, government ID* Your social security card cannot state "NOT VALID FOR WORK."Please upload two months' worth of copies showing proof of income for your primary job(s) or source(s) of income.If your primary job is less than 30 hours, you may upload additional pay stubs from other jobs. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.Please upload two months' worth of copies showing proof of income for your spouse's primary job(s) or source(s) of income.If your spouse's primary job is less than 30 hours, you may upload additional pay stubs from other jobs. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.Please upload a utility bill, cell phone bill, or rent/lease agreement showing proof of addressYour name, or that of your spouse, must be on the statement. Your file will be safely stored on our secure server. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.Please upload a copy of your social security card.Your file will be safely stored on our secure server. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.Please upload a copy of your spouse's social security card.Your file will be safely stored on our secure server. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.Please upload a copy of your employment verification.Your employment verification must show your hire date. If your primary job is less than 30 hours/wk, you may upload more than one verification. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.Please upload a copy of your driver's license or valid, government-issued ID. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.Please upload a copy of your spouse's driver's license or valid, government-issued ID. Drop files here or Accepted file types: png, gif, jpg, jpeg, jfif, doc, xls, docx, xlsx, pdf.If you need more time to gather your files, you can click "Save and Continue" below. Please note, this will generate a link that acts as a password. DO NOT SHARE this link with anyone.If you have questions about this application at any point you may contact Nick at 520-529-1766 x209.You can also click Save and Continue and follow the instructions to pick up at a later time.If you have questions about this application at any point you may contact Anne Marie at 520-622-2801, x7114.You can also click Save and Continue and follow the instructions to pick up at a later time.By signing, you:Agree to complete the free, 16-hour Credit Builder Course offered by Catholic Community Services, Pio Decimo Center,Agree to allow the Program to share any and all disclosed information with Pyramid Federal Credit Union (PFCU) in order to process this loan request,Understand that Pyramid Federal Credit Union will inform the Program of your payment performance,Understand that failure to comply with ABLE Program requirements will be grounds for default, which may result in immediate repayment of the loan balance.Please note that applications will not be reviewed until all documentation has been provided.I will complete the free, 16-hour Credit Builder Course and...*I would like to put aside $10/month extra so that I can receive an additional $120 at the end of the year.I do not want to put aside $10/month. I will make the bare minimum payment.As part of this program, we have a Savings Incentive Match. For borrowers who pay off their loan, complete the Credit Build Course, AND save $10/month, we will match your $120 with another $120 at the end of the year.Signature The digital signature pad is not working or I prefer to provide a signature in person.
