CHEROKEE NATION TRIBAL LOAN PROGRAM



Citizen Potawatomi Jump Start Program Application***************Please do not return this page with application.***************Qualifications:Loan applicants must be at least 18, full-time, active employee of Citizen Potawatomi Nation (CPN) for a minimum of 3 years. Employees recently transferred to a new position within CPN must have completed their probationary period. Applicants may have only one outstanding Jump Start loan at any given time. Loan Amount:The loan amount is determined by a budget analysis and debt to credit ratio.Terms: Maximum repayment terms: 60 months.Interest rate will be fixed at 6-9 points above prime.A Processing fee of $50.00 will be charged for all loans.Loan recipients must attend individualized budgeting and credit counseling sessions.Application:Loan applicant must complete ALL of the boxes on the enclosed application.List all “liabilities”. This includes all types of payments made on a monthly basis.Sign and date the application.Please attach a copy of your driver’s license with your application.Submit your application to the Citizen Potawatomi Community Development Corporation (CPCDC) for processing.Processing:Return all information to the CPCDC.All verifications will be made by the CPCDC staff.Applicants will be notified once their application has completed the verification process and an appointment for the budget analysis will be made to determine the amount and terms of the loan.After you have been approved for the loan you will be free to choose your car from one of our approved vendors.If you have any questions, please contact (405) 878-4697 or email employeeloan@. Return applications to:Citizen Potawatomi Community Development Corporation1545 Gordon Cooper Drive, Shawnee, OK 74801Phone: 405/878-4697 Fax: 405/878-4665employeeloan@ 1828800933450038862003238500Citizen Potawatomi Jump Start Program ApplicationSection A: Primary Applicant InformationFirst Name (please print) FORMTEXT ?????Middle Name FORMTEXT ?????Last Name FORMTEXT ?????Employee Number FORMTEXT ?????Email Address FORMTEXT ?????Ethnicity FORMCHECKBOX Caucasian FORMCHECKBOX Hispanic/Latino FORMCHECKBOX African American FORMCHECKBOX Asian/Other Pacific Islander FORMCHECKBOX Native American If Native American which tribe? FORMTEXT ????? Birth Date FORMTEXT ?????Telephone Number FORMTEXT ?????Driver’s License FORMTEXT ?????Social Security Number FORMTEXT ?????Number of Dependants FORMTEXT ?????Ages of Dependants FORMTEXT ?????Current Street Address FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????County FORMTEXT ?????Do you FORMCHECKBOX OwnHow long FORMTEXT ?????or FORMCHECKBOX Rent?Previous Street Address FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????County FORMTEXT ?????Do you FORMCHECKBOX OwnHow long FORMTEXT ?????or FORMCHECKBOX Rent?Employer & location FORMTEXT ?????Department FORMTEXT ?????Supervisor’s Name FORMTEXT ?????Supervisor Phone FORMTEXT ?????How Long? FORMTEXT ?????Business Phone FORMTEXT ?????Ext FORMTEXT ?????Position or Title FORMTEXT ?????Salary Per MonthGross $ FORMTEXT ?????Net $ FORMTEXT ?????Previous Employer FORMTEXT ?????Address FORMTEXT ?????City, State, Zip FORMTEXT ?????Phone Number FORMTEXT ?????From When? FORMTEXT ?????To When? FORMTEXT ?????Name and address of nearest friend or relative NOT LIVING WITH YOU FORMTEXT ?????Relationship FORMTEXT ?????Telephone Number (including area code) FORMTEXT ?????Name and address of nearest friend or relative NOT LIVING WITH YOU FORMTEXT ?????Relationship FORMTEXT ?????Telephone Number (including area code) FORMTEXT ?????Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.Alimony, child support, separate maintenance received under FORMCHECKBOX Court Order FORMCHECKBOX Written Agreement FORMCHECKBOX Oral UnderstandingOther Employment Income (Employer Name, Address, Phone Number) FORMTEXT ?????Income Per Month FORMTEXT ?????Is any income listed in this Section likely to be reduced before the credit request is paid off? FORMCHECKBOX Yes FORMCHECKBOX No, If yes, please explain: FORMTEXT ?????Have you previously received credit from us? FORMCHECKBOX No FORMCHECKBOX Yes, If yes When? FORMTEXT ?????Section B: Co-Applicant InformationFirst Name FORMTEXT ?????Middle Name FORMTEXT ?????Last Name FORMTEXT ?????Social Security Number FORMTEXT ?????Ethnicity FORMCHECKBOX Caucasian FORMCHECKBOX Hispanic/Latino FORMCHECKBOX African American FORMCHECKBOX Asian/Other Pacific Islander FORMCHECKBOX Native American If Native American what tribe? FORMTEXT ????? Birth Date FORMTEXT ?????Telephone Number FORMTEXT ?????Driver’s License FORMTEXT ?????Social Security Number FORMTEXT ?????Number of Dependants FORMTEXT ?????Ages of Dependants FORMTEXT ?????Current Street Address FORMCHECKBOX if same as Primary Applicant FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????County FORMTEXT ?????Do you FORMCHECKBOX OwnHow long FORMTEXT ?????or FORMCHECKBOX Rent?Previous Street Address FORMCHECKBOX if same as Primary Applicant FORMTEXT ?????City FORMTEXT ?????State FORMTEXT ?????Zip FORMTEXT ?????County FORMTEXT ?????Do you FORMCHECKBOX OwnHow long FORMTEXT ?????or FORMCHECKBOX Rent?Employer & location FORMTEXT ?????Department FORMTEXT ?????Supervisor’s Name FORMTEXT ?????Supervisor Phone FORMTEXT ?????How Long? FORMTEXT ?????Business Phone FORMTEXT ?????Ext FORMTEXT ?????Position or Title FORMTEXT ?????Salary Per MonthGross $ FORMTEXT ?????Net $ FORMTEXT ?????Previous Employer FORMTEXT ?????Address FORMTEXT ?????City, State, Zip FORMTEXT ?????Phone Number FORMTEXT ?????From When? FORMTEXT ?????To When? FORMTEXT ?????Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.Alimony, child support, separate maintenance received under FORMCHECKBOX Court Order FORMCHECKBOX Written Agreement FORMCHECKBOX Oral UnderstandingOther Employment Income (Employer Name, Address, Phone Number) FORMTEXT ?????Income Per Month FORMTEXT ?????Is any income listed in this Section likely to be reduced before the credit request is paid off? FORMCHECKBOX Yes FORMCHECKBOX No, if yes, please explain: FORMTEXT ?????Have you previously received credit from us? FORMCHECKBOX No FORMCHECKBOX Yes, If yes When? FORMTEXT ?????Section C: AssetsDescription of AssetName in Which Account is CarriedEstimated Amount OwedEstimated Value of AssetDo you have a checking account? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you have a Savings account? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you have a 401K? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you have a Certificate of Deposit? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you own Real Estate? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you own more than the $25,000 in Life Insurance CPN Provides? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you own a vehicle? FORMCHECKBOX Yes FORMCHECKBOX No, if yes, please provide Year, Make, & Model FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Do you own any other assets? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total Assets FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Section C: LiabilitiesCreditorName in WhichThe Account is CarriedOriginalAmountPresentBalanceMonthlyPaymentsLandlord or Mortgage Holder FORMTEXT ????? FORMTEXT ?????(Omit if Renting)(Omit if Renting) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Automobile (Year, make, Model) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Automobile (Year, make, Model) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Credit Card FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Credit Card FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Installment Loan FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Installment Loan FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other liability FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total Liabilities FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Are you obligated to make any of the following FORMCHECKBOX Alimony FORMCHECKBOX Spousal Support FORMCHECKBOX Child Support FORMCHECKBOX Maintenance Payments, if yes to whom and the monthly amount? FORMTEXT ?????Are you a co-signor, endorser, or guarantor on any loan or contract? FORMCHECKBOX Yes FORMCHECKBOX No, if yes, to whom and the amount of the monthly payment? FORMTEXT ?????Signatures:I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By signing below, I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.All parties understand and agree that the Citizen Potawatomi Nation Tribal Court has jurisdiction to resolve any dispute under the Citizen Potawatomi Jump Start Program of the Citizen Potawatomi Nation and the parties do herby submit to the personal jurisdiction of, and waive any objection to venue in, the Citizen Potawatomi Nation Tribal Court for the resolution of any dispute arising out of the employee loan program.All costs, fees, and expenses of collection and/or litigation will be charged to the “Employee”, added to the balance of the loan, and withheld from the “Employees” final check.______________________________________________________________________________________________________________Applicant’s SignatureDateCo-Applicant’s SignatureDateRequest for Verification of EmploymentPlease Return To:Citizen Potawatomi Community Development Corporation 1545 Gordon Cooper DriveShawnee, OK 74801I have applied for a loan through the Citizen Potawatomi Jump Start Program. My signature below authorizes verification and release of the information requested. Applicant Name: FORMTEXT ?????Employee Number: FORMTEXT ?????Address: FORMTEXT ?????Social Security Number: FORMTEXT ?????City, St, Zip: FORMTEXT ?????Date of Birth: FORMTEXT ?????Cell Phone: FORMTEXT ?????Home Phone: FORMTEXT ?????Applicant’s Signature: Co- Applicant’s Signature:For Office Use Only:Breakdown of Loan FundsDatePurposeVendorAmountCompleted FORMTEXT ?????Vehicle FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TT&L FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Lien Entry FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Loan Fee(s) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Loan Approved: Amount $ FORMTEXT ?????______________ FORMCHECKBOX Loan Declined: Reason: FORMTEXT ?????______________________________________________________Credit Committee:_________________________________________________________________ FORMCHECKBOX Approved FORMCHECKBOX DeclinedDate_________________________________________________________________ FORMCHECKBOX Approved FORMCHECKBOX DeclinedDateCitizen Potawatomi Financial Wellness CheckupName: FORMTEXT ????? Date: FORMTEXT ?????Complete the following: Mark A for Always, S for Sometimes and N for Never.As a rule, do you: A S N1.Pay your rent/mortgage payment on time? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.Pay your utilities payment on time? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 3.Save 10 percent of your take home pay? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 4.Try to keep three months of your net income in reserve for emergencies? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 5.Plan ahead for large expenses such as buying a car and moving into an apartment? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 6.Set goals and keep a budget for your net income? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 7.Spend no more than 20 percent of your net income for credit payments, FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX excluding home mortgage?parison shop for the purchase of most items? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 9.Use credit only for expensive purchases or when you have the money in the bank FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX to cover the charge?10.Balance your checkbook every month? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 11.Keep yourself financially updated by reading personal FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX financial articles and magazines?Please answer Yes or NoYesNo11. Do you have a checking account? FORMCHECKBOX FORMCHECKBOX 12. Do you have a savings account? FORMCHECKBOX FORMCHECKBOX 13. Do you follow a monthly budget? FORMCHECKBOX FORMCHECKBOX 14. Do you contribute to your 401K plan? FORMCHECKBOX FORMCHECKBOX 15. Do you borrow from payday/loan company lenders? FORMCHECKBOX FORMCHECKBOX ................
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