NMTC Questionnaire

Do you expect to undertake a capital project in the next 2 – 3 years? If so, are you aware of the New Markets Tax Credit Program and the benefits it could provide to your health center in financing a capital project? Capital Link can help your health center take advantage of this valuable program. To assist us in this endeavor, please provide as much of the following information as possible – understanding these may be early estimates:

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* 1. Please provide the following:

Name and Title:

Health Center Name:

State:

Email Address:

Phone Number:

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* 2. What is the address for your project? Please include as much information as possible:

Address:

Address 2:

City/Town:

State: *

ZIP:

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* 3. When do you hope to begin construction on your project? (MM/YYYY)

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* 4. What is the construction type?

New Construction

Renovation

Expansion

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* 5. What is the approximate size and/or square footage of your project?

Project Size $:

Square Footage:

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* 6. Have you completed financial projections for the project?

Yes

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* 7. Have any funds, including grants or capital campaign, already been raised for this project?

Yes (If so, how much?)

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* 8. Do you have preliminary or complete architectural plans for the project?

Yes

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* 9. Please provide any additional comments or project information here.

Should you have any questions, please contact Mark Lurtz at mlurtz@caplink.org.