CBDO Application - Exhibit A

Certification to become a Community Based Development Organization under requirements 24 CFR 570.204 (C)(1)

Agency/Organization

Program/Project Name

Please describe the services (current or proposed) to be funded with Community Development Block Grant (CDBG) funds.

Address

Telephone

Contact Person

Position/Title

Eligibility

The agency will undertake one or more of the following eligible activities: (check all that apply):

Definitions:

Neighborhood Revitalization projects- activities of sufficient size and scope to have an impact on the decline of a geographic location within the City of Detroit (but not the entire City of Detroit) designated in comprehensive plans, ordinances, or other local documents as a neighborhood, village, or similar geographic designation

Community Economic Development projects- activities that increase economic opportunity, principally for persons of low-and moderate-income, or that stimulate or retain businesses or permanent jobs, and projects that consist of one or more such activities that are clearly needed to address a lack of affordable housing accessible to existing or planned jobs

Energy Conservation projects- activities that address energy conservation, principally for the benefit of the low- and moderate-income residents of the City of Detroit

Please specify your area(s) of operation:

Tell us the service boundaries of your agency/organization

Does the agency/organization serve part or all of the City of Detroit NRSA?

You can find a map of the NRSA boundaries at this link on page 63: https://detroitmi.gov/sites/detroitmi.localhost/files/2021-06/2020-2024%20NRSA%20Application%20Final%205.25.21pdf.pdf

Self Certification of Board Members

51% of your agency's governing body must meet one or more of the following criteria:

Low-Moderate Income residents of the agency's geographic area of operation

Owners or Senior officers of private establishments located and serving in the agency's geographic area of operation

Representatives of low to moderate income neighborhood organizations

Type in your agency's board representation below.

Total Board Members

Number of Board members who are low- or moderate-income residents of the agency’s geographic area of operation

Number of Board members who are owners or senior officers of private establishments located in and serving the agency’s geographic area of operation

Number of Board members who are also representatives of low- and moderate- income neighborhood organizations located in its geographic area of operation

Required Supporting Documents - (c)(1)

The following documentation must be attached to the appropriate sections of this application:

Articles of Incorporation (copy) – Must identify the activities that the agency performs and the geographic area of operation.

By-Laws (copy) – Must include a statement of the community economic development activity and the geographic area of operation.

Sam.gov registration

Self Certification Forms A, B, or C for board members who maintain the 51% criteria.

List of Governing Board on Exhibit C.

Drop your files here

Form Date Field

mm/dd/yyyy

Send me a copy of my responses

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