* Required Fields

College/University Name * Club/Organization Name * Applicant Name * Email Address * Why are you choosing to support Domestic Microfinance? * How did you hear about ACCION USA? * How did you hear about the “On Campus” Initiative? * Have you read the On Campus Guide Book? Yes
No Student Group Name * Length of Existence * Number of Members * Professor Advisor * Professor Advisor Title * Professor Advisor Phone Number * Mission of Group * Geographic Focus * Demographic Focus (i.e. women, food/bev industry, size of business/size of loan) * Group Activities to Date * Please list all possible Projections for Partnership (these include Host an Awareness Event, Fundraise, Raise Awareness,Become Referral Partner, Participate in Financial Literacy Programming, Create a Local Lending Guarantee Fund ) * When forming an affiliation with student-led enterprises, ACCION USA prefers to work with groups that have created a vision for sustainability. How do you as a student-led group plan to overcome the high-turn over rate with students? *

Please email your clubs 3-5 year plan and Goals and Deliverables forms to Erica Dorn edorn@accionusa.org