CHDO BOARD MEMBER CERTIFICATION
Name of Organization (prospective CHDO):
LOW INCOME REPRESENTATIVES
Board members meeting Low Income Representation requirement must complete this certification
I represent the interests of low-income families in this organization’s targeted service area. I
have checked below the manner in which I meet the qualification as a low-income
representative:
I qualify as a low-income resident under the HOME Program definition. The gross annual
income of my household of ______ people is at or below 80% of the ________________
(name of county) county area median income in the amount of $_____________ (80%
AMI limit); OR
I live in a low-income area (where 51% or more of the households in my US Census tract
have incomes at or below 80% of the median household income, as defined by HUD),
which is part of the CHDO’s targeted service area. My census tract is _______________
(census tract number). The Census tract data must
accompany this certification. OR
I am an elected representative of _________________________________________
(name of low-income neighborhood organization), located within
____________________________ (name of county) which is part of the CHDO’s targeted
service area. A signed resolution or signed minutes and election roster from the
neighborhood organization naming the individual as its representative on the CHDO’s
board of directors must be provided.
Certification
: I hereby certify that the above is true and correct as of the date of my signature below.
If my status as a Low Income Representative changes at any time during my tenure on the board, I
will immediately notify the board chair and executive director in writing and update my certification.
