Childcare Reinvestment Business (CRiB) Fund Application

Please note: this form is only for the Invest PGH CRiB program. Applicants for all other programs must apply using our universal application.

Thank you for your interest in applying for a CRiB loan with Invest PGH.

Your business must be located within the City of Pittsburgh and the applicable application fee must be paid in order to initiate the review and underwriting process.

Pay CRiB application fee here.

If you are not within City limits, please visit investpgh.org/resources for additional small business resources.

Once your application is submitted and your application fee is received, your assigned lending analyst will be in touch within 3-5 business days.

Do you need assistance with translating, interpreting, or completing this application?

Other

Invest PGH provides language translation and interpretation free of cost. If you require language assistance or need help completing this form, please reach out to info@investpgh.org or call us at 412-255-6547.

How did you hear about the CRiB program?

Have you participated in the Chatham Center for Women's Entrepreneurship Business of Childcare program or the Early Childhood Funders Alliance of Western Pennsylvania training?

Applicants who participate in the Chatham CWE Business of Childcare program or the Early Excellence Project training are eligible for an extra $5,000 in CRiB funding upon completion of the course.

Have you previously received a CRiB loan?

Currently, applicants are eligible for one (1) CRiB loan. If you have previously received a CRiB loan and need additional financing, we welcome you to fill out our universal application.

Have you worked with the URA or Invest PGH before?

Name of principal owner:

Please note that throughout this form, "you" refers to the principal owner of the business.

Gender identity of principal owner (you may choose more than one):

Race and/or ethnicity of principal owner (you may choose more than one):

Are there additional business owners or managers?

Names and titles of additional owners or managers:

Describe the structure of your business:

Owner -> management -> subordinates/staff or similar

Are all owners of the business current on both personal and business taxes?

Are any owners of the business in default on any obligations owed to the URA, Invest PGH, the City of Pittsburgh, Allegheny County, or the state and/or federal government?

Legal business name:

Fictitious business name:

Such as a DBA (doing business as) or similar

Legal business structure:

Please supply the names and titles of the nonprofit's board of directors:

EIN

Employer Identification Number

City of Pittsburgh tax ID number:

Amount of funds requested (up to $20,000):

Describe the purpose of the funds requested:

How much equity (your own funds) have you or the principal owner invested into the business within the last six months?

Business address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is the facility center- or home-based?

Do you own or rent the facility?

Please provide a copy of the lease agreement, if applicable:

Business phone:

Please enter a valid phone number.Format: (000) 000-0000.

Business email:

example@example.com

Business website:

Business social media:

Business description:

Business plan:

How many children is the facility licensed to serve?

How many children are enrolled at the facility?

What is the age range of the children the facility serves?

What percent of the children at the facility are receiving subsidies?

How many staff does the facility currently employ?

Please provide the names and titles of the personnel employed at the facility, as well as a brief bio or description of their experience in the field of child care:

Please include yourself in the above response.

How many additional staff does the facility currently expect to hire?

In the section below, please upload the requested documents.

W-9 Form

Request for Taxpayer Identification Number and Certification

The federal W-9 form can be found here.

State or federal ID

A scan or photo of your driver's license, passport, or other government-issued identification

Personal federal income tax return for the prior year

Business federal income tax return for the prior year

Certificate of Compliance (child care license) or provisional license from the Pennsylvania Department of Human Services

Keystone STARS certificate

Current revenues and/or statement of profit & loss

I have paid the CRiB application fee.

Signature