Kiva US Hub Interest Application

First Name

Last Name

Work Email

Phone

Organization Name?

Organization Website

Title within Organization

Address

States

City

Zip Code

If you have an annual report, please provide a link to it here:

What geography does your organization serve?

Please be specific if you serve a specific region, set of cities, etc.

What is the population size of the geography your organization serves? (an estimation is fine)

How many staff members does your organization have?

If other, what demographic(s) of entrepreneurs do you focus on?

How did you learn about Kiva Hubs?

History with Kiva

How did you learn about Kiva?

Please describe how you learned about Kiva

Have you or your organization engaged with Kiva before?

YesNoEx: trustee, referral partner, or individual lender

Please briefly explain.

Is a Kiva hub right for your Organization?

To leverage Kiva's platform and lending capital at scale, Hubs agree to the following commitments. Please indicate your capacity on each commitment:

	Yes	No	Unsure, interested in more information
Staffing a 'Capital Access Manager' to manage the Kiva program for the geography that your Hub is serving (min 15 hours/week)
Commitment to an annual cost-coverage fee for onboarding, backend access and loan processing on Kiva
Aiming to facilitate at least 20 loans a year
Equitably service every Kiva applicant through each phase of the Kiva process (application, fundraising, repayment)
Knowing what you know now, are you interested in building your organization's capacity to become a Hub?

Do you have a sense of your intended commitment as a Kiva Hub?

Do you have any other additional comments, questions, or concerns you'd like to share with the team?