Opportunity Appalachia Application Form

Lead Contact:(Required)

Applicant Organization:(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Work Phone(Required)

Mobile Phone

Email(Required)

Narrative Responses

Note: Narrative responses to each question are limited to 2,500 characters unless otherwise noted.

1. Communities targeted by this application (municipality(ies), county(ies), and census tract(s):(Required)

Note: See Appendix I in PDF for a list of eligible counties.

2. Service area of applicant (note if different than above, or note same):(Required)

3. Community Development Strategy(ies):(Required)

(for example: housing, downtown development, manufacturing, IT, healthcare, education, food systems, clean energy, heritage tourism and recreation, addiction treatment and recovery, or describe other strategies) Describe how your strategy aligns with broader community-identified plans or priorities. Please include the level of community engagement or support there is for this strategy or specific project.

4. Proposed Projects (list up to 3):

I. Name of Project, address(Required)

Size

In Sq Ft.

Total anticipated project cost:

$

Financing identified/anticipated

List source and $ or note ‘None’:

Project description:(Required)

Provide url link if available.

Community Impact (quantify / provide estimates):(Required)

(for example: the creation of quality jobs with good pay and benefits (# of jobs, pay rates, benefits provided), jobs with training and advancement opportunities, jobs accessible to unemployed / underemployed persons, project supports community economic diversification, creates vibrant places for follow-on investment, other impacts ...)

Name(s) of project sponsors, developer, and/or business owner, if identified:

Technical Assistance Needed:

(e.g., business plan development, financial pro forma development, financial structuring of transaction, market assessment, feasibility assessment, developer identification, architectural drawings, capital raise)

Proposed Project:

II. Name of Project, address

(Leave blank if not applicable)

Size

In Sq Ft.

Total anticipated project cost:

$

Financing identified/anticipated

List source and $ or note ‘None’:

Project description:

Provide url link if available.

Community Impact (quantify / provide estimates):

(for example: the creation of quality jobs with good pay and benefits (# of jobs, pay rates, benefits provided), jobs with training and advancement opportunities, jobs accessible to unemployed / underemployed persons, project supports community economic diversification, creates vibrant places for follow-on investment, other impacts ...)

Name(s) of project sponsors, developer, and/or business owner, if identified:

Technical Assistance Needed:

(eg business plan development, financial pro forma development, financial structuring of transaction, market assessment, feasibility assessment, developer identification, architectural drawings, capital raise, ...)

Proposed Project:

III. Name of Project, address

(Leave blank if not applicable)

Size

In Sq Ft.

Total anticipated project cost:

$

Financing identified/anticipated

List source and $ or note ‘None’:

Project description:

Provide url link if available.

Community Impact (quantify / provide estimates):

(for example: the creation of quality jobs with good pay and benefits (# of jobs, pay rates, benefits provided), jobs with training and advancement opportunities, jobs accessible to unemployed / underemployed persons, project supports community economic diversification, creates vibrant places for follow-on investment, other impacts ...)

Name(s) of project sponsors, developer, and/or business owner, if identified:

Technical Assistance Needed:

(eg business plan development, financial pro forma development, financial structuring of transaction, market assessment, feasibility assessment, developer identification, architectural drawings, capital raise, ...)

5. Clean Energy Focus:(Required)

The selection process includes prioritization of projects with Clean Energy features. This could include solar power generation, energy efficiency measures, etc. Please be sure to describe and quantify these anticipated impacts. If not described above, please describe here.

6. Applicant Capacity:(Required)

What is the relationship of the applicant to the community? How has the community demonstrated its support of the project(s)? Describe the applicant’s capacity for completing or overseeing project activities:

7. Provision of Technical Assistance:
The types of technical support that may be provided by the Opportunity Appalachia program include: development of investment prospectus, preparation of pro forma financial projections, structuring of project financing, market research/demand assessment, identification of project developers and business operators, feasibility assessment, outreach for project finance/investment, architectural and engineering, and other types of support. This support will be paid directly to the selected and experienced providers on contract, determined by a competitive bid process. Roughly $40,000 - $75,000 will be provided for selected project. The Scope of Work timeline for the provision of technical support is anticipated to be 6 – 12 months, from June 2024 to June 2025, with capital raise activities beginning in Q4 2024 – Q2 2025.

If you've received cost estimates from potential providers for the technical assistance you need, please provide here; or state ‘Unknown $’.(Required)

Please complete either b) or c), below. No preference is given in the Opportunity Appalachia selection process to either 7(b) or 7(c).

Applicants may choose to use technical assistance providers offered by Opportunity Appalachia or may work with technical assistance providers they have identified.

b) If known, please provide name(s) and contact information of Technical Assistance provider(s) you prefer to support the above project activities.

Note: Note: Each TA provider must complete the Request for Qualifications, see Appendix III, to be eligible to provide TA for this program. If your project is selected to participate in Opportunity Appalachia, proposals from Technical Assistance providers will be required, which will be reviewed for adequacy and cost effectiveness.

Name 1: Contact Name

First Last

(Leave blank if not applicable)

Company Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email

Phone

URL

Name 2: Contact Name

First Last

(Leave blank if not applicable)

Company Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email

Phone

URL

Name 3: Contact Name

First Last

(Leave blank if not applicable)

Company Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email

Phone

URL

c) Technical Assistance providers have not yet been identified.

The Applicant requests Opportunity Appalachia identify / recommend suitable technical support organizations.

8. Match Requirement:(Required)

Applicants selected to participate will be required to provide $5,000 of matching support. This matching support can either be in-kind from community leads or members, developers and business owners, or through a cash contribution to the prospectus development and related activities. If selected to participate in the Opportunity Appalachia program, our community commits to provide $5,000 of cash or in-kind matching support for this effort.

Initial

9. Attestation:(Required)

Date of Submission:

Name

Title:

Organization:

Opportunity Appalachia

Application Form 2024

Narrative Responses

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