Certification of Material Event Form: Revised September 2010
6. If a prior awardee or allocatee, will the event(s) have any effect on the organization’s
ability to comply with the reporting requirements set forth in the organization’s award
Yes
No
agreement?
If yes, please describe:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
7. If a prior awardee or allocatee, will the event(s) cause the organization to be in non-
compliance with an existing award agreement and/or necessitate the organization to seek
Yes
No
an amendment to its existing award agreement?
If yes, please describe:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
8. Will the event(s) have any effect on a pending application with one or more of the CDFI
Yes
No
Fund’s Programs?
If yes, please describe:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
To the best of my knowledge and belief, all information contained in this
certification statement is true and correct. My signature indicates authorization on
behalf of the organization’s governing body.
Authorized Representative Signature:
Title:
Date:
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