Personal IDA Application

PERSONAL IDA APPLICATION

Applicant Information

Date of Application:

Household & Income

Household Size (number of persons living in household):

Savings Plan & Goal

Intended Asset for Matched Savings (select one or more):

Anticipated Date to Complete Goal:

Banking Information (for deposits)

Program Terms, Use of Matched Funds, and Certification

By submitting this application, the Applicant certifies that the information provided is true and complete to the best of the Applicant's knowledge. The Applicant understands and agrees that acceptance into the Individual Development Account program is contingent upon verification of eligibility and program capacity. The Applicant further acknowledges the following material program terms, which govern participation:

1. Matching Funds and Qualified Purchases: Matched funds are earned only for verified deposits made to the program account and may be applied only to qualified asset purchases approved by the program (e.g., home purchase down payment, postsecondary education expenses, business start-up costs, or approved vehicle purchase). Withdrawals for non-qualified purposes will result in forfeiture of match funds and may require repayment.

2. Match Rate, Caps and Period: The program's match rate, maximum match per participant, and the period during which deposits will be matched are established by program staff and will be communicated upon approval. Match rates may be subject to program funding and may be adjusted prospectively; applicants will be notified in writing of the applicable rate for their enrollment period.

3. Minimum Deposits and Account Activity: The Applicant must make regular deposits as set out in the accepted savings plan. Failure to maintain active deposits or prolonged inactivity may result in removal from the program and potential loss of matching eligibility.

4. Financial Education Requirement: Completion of required financial education or counseling sessions is a condition of receiving matched funds. The Applicant agrees to attend scheduled sessions and provide documentation of completion when requested.

5. Early Withdrawal, Forfeiture and Default: Early non-qualified withdrawals, failure to comply with program rules, or discovery of material misrepresentation may result in forfeiture of matches, account closure, and requirement to return matched funds. Program staff reserve the right to close accounts for cause after written notice.

6. Tax Treatment and Reporting: The Applicant acknowledges that interest and matched amounts may be reportable for tax purposes and is responsible for any tax liability. The program will provide any required tax documentation to the Applicant and relevant authorities.

Authorization to Verify Information

I authorize program staff, its agents, and designated partners to verify the information contained in this application, including but not limited to income, household composition, employment status, public benefit receipt, and banking information. I consent to the release of information and records necessary to determine eligibility and to monitor compliance with program requirements. This authorization includes the exchange of information with employers, financial institutions, public benefits administrators, and other agencies as necessary for program administration.

Additional Information & Barriers

Program Use Only

Applicant Certification and Signature

I certify under penalty of perjury that the information provided in this application is true, correct and complete. I understand that knowingly providing false information may result in denial of enrollment or termination from the program and may require repayment of any matched funds disbursed. I hereby authorize verification of the information contained in this application by program staff and their authorized partners. I understand that I must comply with program rules, complete required financial education, and obtain program approval prior to purchase of the intended asset in order to receive matched funds.

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