Loan Recipient Reporting and Self-Evaluation Form

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Meyer Foundation Nonprofit Sector Fund

Cash Flow Loan Program

Loan Recipient Reporting and Self-Evaluation Form

Name of Organization:
Loan Amount:
Loan Date:
Repayment Due Date:
Repayment Date Actual:
Name of Person Completing Form:
Telephone: Fax:
Executive Director Signature:
Board Chairperson Signature:

Please answer the following questions as completely and accurately as possible. If you require additional space for your replies, please attach them to this form.

This form can also be sent electronically if you prefer.
The information contained in this questionnaire will be kept confidential. Its purpose is to improve the ability of the Meyer Foundation’s Cash Flow Loan Program to better serve nonprofit organizations. Should you have any questions or comments, please contact Richard Moyers at 202-483-8294.
Your thoughtful responses will help us improve our program.

Please describe the reason(s) for your organization’s request to the Meyer Cash Flow Loan Program.

Please describe how the loan funds were used.

Has your organization implemented any changes in financial management process or policies as a result of participating in the Cash Flow Loan Program?

We want to understand more about the impact of cash flow loan use in general operations. To what degree did your organization’s use of the Cash Flow Loan Program result in the following outcomes?

	None	Very Little	To some degree	Substantial	Not Applicable
Increased agency’s financial stability	0	1	2	3	N/A
Increased agency’s service delivery capacity	0	1	2	3	N/A
Increased agency’s level of information about financial status	0	1	2	3	N/A
Increased quality of financial planning	0	1	2	3	N/A
Improved financial records and systems	0	1	2	3	N/A

Please comment on information above:

What was it about the Meyer Cash Flow Loan Program that made it a good choice for you to address a particular cash flow program?

How did you learn of the Cash Flow Loan Program?

What do you feel would be the most effective way for the Meyer Foundation to promote the use of the program by organizations?

Has your organization participated in other cash flow loan programs during the past three years?

_______No Yes (please describe)

We want the Meyer Cash Flow Program to be as helpful as possible to nonprofit organizations. Please rate and comment on the following elements of the Cash Flow Program as your organization experienced them. Specific comments will be helpful to us in making improvements to the program.

	Poor	Fair	Good	Excellent	N/A
Helpfulness of the program materials	1	2	3	4	N/A
Please Comment:
Loan Application Process	1	2	3	4	N/A
Please Comment:
Interview Process	1	2	3	4	N/A
Please Comment:
Loan Amount and Limits	1	2	3	4	N/A
Please Comment:
Repayment Policies	1	2	3	4	N/A
Please Comment:
Meyer Foundation Staff Assistance	1	2	3	4	N/A
Please Comment:

Please list any changes you might suggest to strengthen the Meyer Cash Flow Loan Program?

Does your organization plan to use the Meyer Cash Flow Loan Program again?

Any other comments or suggestions?

Thanks for your help!