CERTIFICATION OF MATERIAL EVENTS FORM 

Organization Name 

EIN #: 

Certification Control 

number (if available): 

Definition: 

A “Material Event” is an occurrence that affects an organization’s strategic direction, 

mission, or business operation and, thereby, its status as a certified Community 

Development Entity (CDE) and/or Community Development Financial Institution 

(CDFI), and/or its compliance with the terms and conditions of its assistance/allocation 

agreement. For additional guidance on what constitutes a Material Event, refer to the 

“Frequently Asked Questions (FAQ): Material Event Occurrence and Reporting” 

document available on the Fund’s website. 

Instructions: 

This form is to be used by CDFI Fund Awardees, applicants, and certified CDEs and 

CDFIs, to report potential Material Events to the CDFI Fund. The Certification of 

Material Events form must be signed by the organization’s Authorized Representative. 

The completed form should be addressed to the attention of the Certification, Compliance 

Monitoring and Evaluation Manager and emailed to ccme@cdfi.treas.gov or faxed to 

(202) 622-7754. Please attach additional pages if necessary. 

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PAPERWORK REDUCTION ACT NOTICE 

CDFI - 0036 

OMB Control Number 1559-0037 

This submission requirement is provided to CDFI Fund Awardees, applicants, and certified CDEs 

and CDFIs, to report potential Material Events to the CDFI Fund. CDFI Fund Awardees, 

applicants, and certified CDEs and CDFIs, are not required to respond to this collection of 

information unless it displays a currently valid OMB number. The estimated average burden 

associated with this collection of information is 0.25 hours. Comments concerning the accuracy of 

this burden estimate and suggestions for reducing this burden should be directed to the CDFI 

Fund, Department of the Treasury, Community Development Financial Institutions Fund, 601 13th 

Street, NW, Suite 200 South, Washington, DC 20005. 

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Certification of Material Event Form: Revised September 2010 

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Please check the appropriate box for the reporting entity as of the date this form is 

signed: 

 I certify that no Material Event has occurred in the reporting entity since the date of its 

most recent certification/re-certification and/or the most recent submission of a Material 

Events Form. 

 A Material Event(s) has (have) occurred in the above-named organization. I certify 

that the event(s) listed below constitute all of such Material Events (attach additional 

pages if needed). 

Explanation of Material Event

Please provide a narrative explanation regarding the Material Event affecting the 

organization including, a timeline and the name and contact information of key people 

involved in the action. 

Date of Material Event(s): 

Explanation of Material Event(s): 
Certification of Material Event Form: Revised September 2010 

3

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 

Governing Board) of the organization? Yes No 

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 No 

If yes, please describe: 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________ 

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

status (e.g., Accountability, Target Market/Service Area, etc.)? Yes No 

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 

(QEIs)? Yes No 

If yes, please describe: 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________ 

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

legal name, EIN, fiscal year, etc.)? Yes No 

If yes, please describe: 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________ 
Certification of Material Event Form: Revised September 2010 

4

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 

agreement? Yes No 

If yes, please describe: 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________ 

7. If a prior awardee or allocatee, will the event(s) cause the organization to be in noncompliance with an existing award agreement and/or necessitate the organization to seek 

an amendment to its existing award agreement? Yes No 

If yes, please describe: 

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________ 

8. Will the event(s) have any effect on a pending application with one or more of the CDFI 

Fund’s Programs? Yes No 

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: