Indicates required field OMB Control Number 3133-0202Note, closing this window at any time prior to submission will result in the loss of content entered.You may work offline by saving a PDF version of this page. Use your browser's print feature or click on the print icon located in the upper right corner of the page. Enter all information into the PDF, then copy and paste from the PDF into this online form when you are ready to submit.IntroductionThe Proof of Concept (POC) Form consists of the following four critical elements. A discussion about each of the elements must be completed for your proposed credit union to be considered:Purpose and Core ValuesField of MembershipCapitalSubscribersDo not close your browser before submitting, or your progress will be lost.If you have any questions, please contact dcamail@ncua.gov or CURE, National Credit Union Administration, 1775 Duke Street, Alexandria, VA 22314.Contact InformationPlease select one primary AND one secondary contact to be responsible for this Proof of Concept form. Multiple people are allowed to be associated with the application. The primary contact will receive the notifications related to this request. Primary Contact Name Telephone Number International phone number, e.g.: +1-555-555-5555 E-mail Address Secondary Contact Name Telephone Number International phone number, e.g.: +1-555-555-5555 E-mail Address General InformationProposed Credit Union Name First Choice Second Choice Acknowledgment of ResearchingAll Subscribers have reviewed and are familiar with the NCUA documents outlined in NCUA's Federal Credit Union Charter Application Guide. In addition, subscribers are familiar with the regulatory and consumer requirements for chartering and operating a federal credit union. We have researched requirements for the following:Low-income designation (LID)Community Development Financial Institution (CDFI) designationMinority Depository Institution (MDI) designation Subscriber Research Did the subscribers conduct extensive research into credit unions and the rules and regulations that govern them? Describe research completed. I (primary contact) acknowledge we have researched the requirements listed above. Minority Group Type Would one or a combination of the following groups represent a popular majority of the potential members you plan to serve? - Select -YesNo Select each group you plan to serve. African American Asian American Hispanic American Native American Financial Services and Products CategorySelect a category of financial services and products that your proposed credit union will offer members. Choose from one of the categories below. Basic service – Limited products and services are offered, for example, regular shares and signature loans only. Intermediate service – The services are more sophisticated than the basic services but are not considered complex. For example, auto loans are one example of an intermediate loan product. Complex service – A full-complement of products and services to include mortgages, home equity loans, member business loans, electronic services, financial education, etc. Purpose and Core Values A credit union is a member-owned and -controlled, not-for-profit cooperative financial institution formed to permit groups of persons to save, borrow, obtain financial services, and participate in its management. Member ownership and control are what make credit unions unique. Think about the following as you describe the reason your organizing group wishes to form a credit union.What is the credit union's mission statement?What are the products and services you plan to offer?Describe future plans or goals on expanding services to ensure long-term viability.Did the subscribers conduct extensive research into credit unions and the rules and regulations that govern them? Describe research completed.Mission Statement What is the credit union's mission statement? Products and Services What are the products and services you plan to offer? Future Plans for Expanding Describe future plans or goals on expanding services to ensure long-term viability. Field of MembershipPotential credit union members must qualify for membership by belonging to a specific group with a common bond. That common bond is known as the Field of Membership (FOM). The three FOM types are Single Common Bond, Multiple Common Bond, and Community. A brief definition of each FOM type is provided below. A Single Common Bond FOM can be occupation based (i.e., employees of an entity or a trade, industry, or profession (TIP)) or association based (i.e., members and employees of an association).A Multiple Common Bond FOM serves multiple entities. Each entity has its own common bond but does not share the same single common bond with the other entities.A Community FOM must be based on a single, geographically-well-defined local community, neighborhood, or rural district where individuals have common interests and/or interact. More than one credit union may serve the same community. A community is defined as either a single political jurisdiction or a multiple contiguous political jurisdiction.Each FOM type includes sub-categories with distinctive regulatory requirements. These requirements must be satisfied by your organizing group in order to obtain a federal charter. For a complete description of each FOM type and the respective sub categories, please refer to the Definitions section.Field of Membership Types What field of membership (FOM) type do you want to serve? Single Common Bond with Associational Group Single Common Bond with Occupational Group Multiple Common Bond with Associational Group(s) Multiple Common Bond with Occupational Group(s) Multiple Common Bond with both Associational Group(s) and Occupational Group(s) Community Number of Potential Members How many potential members are in your proposed field of membership? How did you determine the number of potential members? FOM Documentation Send as email attachment(s) all applicable field of membership documents based on your field of membership type. For additional information, see the Federal Credit Union Charter Application Guide for a list of these documents. Send email to dcamail@ncua.gov Low-Income Designation The NCUA's low-income designation (LID) is a classification for credit unions that meet certain membership criteria. To qualify, a majority (greater than 50%) of your membership must meet the criteria set forth by the NCUA. Contact CURE at dcamail@ncua.gov for more information. Is your organizing group interested in the NCUA's low-income designation? - Select -YesNo Capital Funding PlanAn organizing group must identify and secure donated capital. It may take a few years to achieve profitability. The amount of donated capital needed depends on the complexity of the financial services offered and the projected asset size. Donated capital covers operating losses until the credit union is profitable. Think of donated capital as a gift to the credit union. The funds are not a deposit, investment, or loan, meaning the funds will never be repaid to the organization or individuals donating the money.Identify how much capital you have obtained commitments for, the source of capital, and any other relevant information. Discuss any non-cash contributions to capital (in-kind donations) and provide supporting documents. Commitment letters from some or all donors strengthen the support for the plan. If you have commitment letters, you may submit them now.Alternatively, you may submit them in Phase 2. State how long your sponsors have committed to providing long-term support (more than five years).Funding Sources What are your sources of donated capital? Amount of Capital Donated What is your total estimated amount of donated capital? $ Years of Sponsor Support How many years do you anticipate your sponsor's support, if applicable? Formal Sponsor Support Do you have formal commitment letters from the sponsor or other organizations providing start-up capital yet? - Select -YesNo Include as email attachment(s) all applicable commitment letters that formally indicate the amount of sponsor support and the length of time the sponsor will support the proposed credit union. Commitment letters must state the sponsor has no expectation of repayment. For additional information, view a sample commitment letter. Send email to dcamail@ncua.gov Subscribers You are required to have at least seven subscribers of good character and fitness who will be involved in the chartering process. Consider seeking subscribers with diverse backgrounds that include accounting, finance, marketing, legal, and operations experience. Collectively, this group should have the knowledge, skills, and abilities to operate a credit union successfully. Please enter the names, phone numbers, and email addresses of the subscribers for your organizing group (at least seven are required) Subscriber 1 Name Subscriber 1 Telephone International phone number, e.g.: +1-555-555-5555 Subscriber 1 Email Address Subscriber 2 Name Subscriber 2 Telephone International phone number, e.g.: +1-555-555-5555 Subscriber 2 Email Address Subscriber 3 Name Subscriber 3 Telephone International phone number, e.g.: +1-555-555-5555 Subscriber 3 Email Address Subscriber 4 Name Subscriber 4 Telephone International phone number, e.g.: +1-555-555-5555 Subscriber 4 Email Address Subscriber 5 Name Subscriber 5 Telephone International phone number, e.g.: +1-555-555-5555 Subscriber 5 Email Address Subscriber 6 Name Subscriber 6 Telephone International phone number, e.g.: +1-555-555-5555 Subscriber 6 Email Address Subscriber 7 Name Subscriber 7 Telephone International phone number, e.g.: +1-555-555-5555 Subscriber 7 Email Address Submission To save a copy before submitting, select the print button at the beginning of this form to print a paper copy or save to a pdf document. Do not close your browser or this tab before submitting, or your progress will be lost. To submit, scroll to the bottom of the page and click the submit form button. Privacy Notice The information collected is solicited to provide NCUA with data that is necessary for screening charter applications. NCUA securely maintains all personally identifiable information provided on this form, and only shares it outside of NCUA if required by law or regulation. For additional information, please contact privacy@ncua.gov. PRA StatementAccording to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, an information collection unless it displays a valid OMB control number. Comments concerning the accuracy of this burden estimate and or any other aspect of this information collection, including suggestions for reducing this burden should be sent to: NewFCU@ncua.gov.NCUA Accessibility StatementPlease review the NCUA Accessibility Statement for additional information about accessibility of the NCUA website. Leave this field blank
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