Certification Of Material Events Form (Page 3 of 4) in pdf

Certification of Material Event Form: Revised September 2010

Please answer the following questions with respect to the Material Event(s) affecting

the organization:

1. Will the event(s) have any effect on the key personnel (e.g., management team and/or

Yes

Governing Board) of the organization?

If yes, please describe:

_______________________________________________________________________

2. Will the event(s) have any effect on the organization’s business strategy (e.g., project

selection criteria, product/investment criteria, investments in unrelated entities, etc.)? □

Yes

If yes, please describe:

_______________________________________________________________________

3. Will the event(s) have any effect on the organization’s CDFI and/or CDE certification

Yes

status (e.g., Accountability, Target Market/Service Area, etc.)?

If yes, please describe:

_______________________________________________________________________

4. Will the event(s) have any effect on the organization’s ability to administer any current

or anticipated awards from one or more of the CDFI Fund’s award programs, including

drawing down undisbursed and/or raising additional Qualified Equity Investments

Yes

(QEIs)?

If yes, please describe:

_______________________________________________________________________

5. Will the event(s) result in any changes to one or more myCDFI Fund accounts (e.g.,

Yes

legal name, EIN, fiscal year, etc.)?

If yes, please describe:

_______________________________________________________________________

Certification Of Material Events Form Page 3