CHDO STAFF MEMBER CERTIFICATION
Name of Organization (prospective CHDO):
PUBLIC OFFICIAL/GOVERNMENTAL EMPLOYEE
All staff members of the prospective CHDO must complete this certification
For purposes of this certification, governmental entities include any participating jurisdiction, other
jurisdiction (e.g. state or local government)
, Indian tribe, public housing agency, Indian housing
authority, housing finance agency, or redevelopment authority.
Public officials include any individual who is an elected or appointed member of any of governmental
entity (e.g. a city council member, a member of the local zoning board, a member of a local public
housing authority board, etc.).
A government employee is anyone who is employed by a governmental entity on a full or part time basis
even if that individual’s job function is not related to housing, HUD programs, or other federal funding
(e.g. a county sheriff deputy, a sanitation department worker, a secretary in the city parks department,
etc.).
[] I am not a public official and/or an employee of a governmental entity.
OR
[] I am a public office and/or an employee of a governmental entity. If checked, describe your role
and identify the governmental entity:
Certification: I hereby certify that the above is true and correct as of the date of my signature below. If
my status as a public office and/or government employee changes at any time during my tenure on the
staff, I will immediately notify the executive director in writing and update my certification.
