Fillable Public Sector Representation Form (CITY OF ROCKFORD)

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Public Sector Representation Form (CITY OF ROCKFORD)

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The Public Sector Representation Form (CITY OF ROCKFORD) form is 1 page long and contains:

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  • 2 check-boxes
  • 10 other fields

Country of origin: US
File type: PDF

U.S.A. forms for CITY OF ROCKFORD

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Board Membership - Public Sector Representation
The HOME requirements related to public sector representation on CHDO boards are intended to ensure that a separation
exists between Participating Jurisdictions (City of Rockford) and CHDOs and that CHDOs are indeed community based and
community-controlled organizations.
If you are a Board member meeting one of the definitions of a public office below, please complete this form and indicate
indicate which definition you meet by placing a check in the box.
Board Member Name:
Address:
City: State: Zip Code:
Place of Employment:
Title:
1 A public official, including:
- Elected officials (council members, alderman, commissioners, state legislators, members of a
school board, etc.)
- Appointed public officials (members of a planning or zoning commission or of any other
regulatory and/or advisory commissions appointed by public official).
- Public employees (employees of public agencies or departments of a PJs government,
including a clerk in the water and sewer department, a public facility janitor or a secretary in the
tax assessment office).
2 Appointed by a public official (any individual who is not necessarily a public official as defined
above, but who has been appointed by a public official to serve on the CHDO board).
I certify that the information above is true and complete to the best of my knowledge on the date hereof.
Signature of Board Member
Date
************************************************************************************************************************************
Official Use Only:
The Board member has met the requirements necessary to qualify as a public official counting toward the
public sector limitation.
CITY OF ROCKFORD APPROVED BY:
Grants Compliance Specialist I Date
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Public Sector Representation Form (CITY OF ROCKFORD)

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Completed 25 February 2021

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