representation that member brings to the Board. Please list only current or approved board members. Do not list prospective board members who have not been approved to join the board. BOARD OF DIRECTORS SECTOR LOW-INCOME QUALIFYING CRIERIA REPRESENTATION (1/3 of board must qualify in one of the below categories) NAME OF CHDO: At a minimum, one-third Low-Income Resident, Elected of the board must be Representative comprised of low-income Neighborhood of Low-Income on Page of representatives and a Organization file with (identify census maximum of one-third of (identify the board may be public organization) officials, appointees or employees of public agencies Name: Public: Household Census Tract: Organization: Size: Title: Private: Occupation: Low-Income: Address: % area Median Employer: Income: Term: from: to: Years as Board Member: Name: Public : Household Census Tract: Organization: Size: Title: Private: Occupation: Low-Income: Address: % area Median Employer: Income: Term: from: to: Years as Board Member: Name: Public: Household Census Tract: Organization: Size: Title: Private: Occupation: Low-Income: Address: % area Median Employer: Income: Term: from: to: Years as Board Member: Name: Public: Household Census Organization: Size: Title: Private: Occupation: Low-Income: Address: % area Median Employer: Income: Term: from: to: as Board Member: DUPLICATE THIS PAGE AS NECESSARY TO INCLUDE ALL BOARD MEMBERS I certify that the listing of current, participating board members is accurate. By:____________________________________ ___________________ Date (Signature) Name of Signatory Its: Role of Signatory CERTIFICATION OF SIGNATURES AND ADDRESSES The Board of Directors of Organization Name met on and authorized the below named individuals to sign contracts, amendments, disbursement requests and other documents requiring such signatures as a part of the CHDO Certification program:
representation that member brings to the Board. Please list only current or approved board members. Do not list prospective board members who have not been approved to join the board. BOARD OF DIRECTORS SECTOR REPRESENTATION LOW-INCOME QUALIFYING CRIERIA (1/3 of board must qualify in one of the below categories) NAME OF CHDO: Page of At a minimum, one-third of the board must be comprised of low-income representatives and a maximum of one-third of the board may be public officials, appointees or employees of public agencies Low-Income on file with Resident, Neighborhood (identify census Elected Representative of Low-Income Organization (identify organization) Name: Title: Occupation: Employer: Term: from: to: Years as Board Member: Public: Private: Low-Income: Household Size: % area Median Income: Census Tract: Address: Organization: Name: Title: Occupation: Employer: Term: from: to: Years as Board Member: Public : Private: Low-Income: Household Size: % area Median Income: Census Tract: Address: Organization: Name: Title: Occupation: Employer: Term: from: to: Years as Board Member: Public: Private: Low-Income: Household Size: % area Median Income: Census Tract: Address: Organization: Name: Title: Occupation: Employer: Term: from: to: as Board Member: Public: Private: Low-Income: Household Size: % area Median Income: Census Address: Organization: DUPLICATE THIS PAGE AS NECESSARY TO INCLUDE ALL BOARD MEMBERS I certify that the listing of current, participating board members is accurate. By:____________________________________ ___________________ (Signature) Date Name of Signatory Its: Role of Signatory CERTIFICATION OF SIGNATURES AND ADDRESSES The Board of Directors of Organization Name met on and authorized the below named individuals to sign contracts, amendments, disbursement requests and other documents requiring such signatures as a part of the CHDO Certification program: