ELP Quarterly Report Form

After the Loan Fund has been active for 6 months, please submit this form with your credit union’s loan reporting template on a quarterly basis. Submission of this form will serve as a reimbursement request for loan loss funds. Loans must be delinquent for 90 days before a credit union can claim reimbursement.

Credit Union*
Credit Union Contact*
Region*
Total Number of Loans for Charge Offs*
Please indicate the total number of loans you are requesting to be reimbursed for due to being charged off. Loans must be in delinquency for 90 days before a credit union can claim reimbursement from the Loan Fund.
Total Request for Standard Risk Loans*
Please indicate the total amount of reimbursement for standard risk loans that have been charged off. If not applicable, please put '0'.
Total Request for High-Risk Loans*
Please indicate the total amount of reimbursement for high-risk loans that have been charged off. If not applicable, please put '0'.
Total Request for SDL/MMT Pilot Loans
Please indicate the total amount of reimbursement for loans from the Portland SDL pilot group.
Loan Fund Report
Please upload an updated loan report with each charge off identified from the original loan list.
Max. file size: 256 MB.