HUD Form 50153.pdf

OMB Approval Number: 2501-0033 Expires (12/31/2018)

HUD Form 50153 (09/2014)

Certification of Consistency with Promise Zone Goals and Implementation

I certify that the proposed activities/projects in this application are consistent with the goals of the Promise Zones and the revitalization strategies detailed in my Promise Zone application.

(Type or clearly print the following information)

Applicant Name:

Name of the Federal Program to which the applicant is applying:

Name of the Promise Zone Designated Community:

The proposed project meets the following geographic criteria (please select one):

The proposed project is solely within Promise Zone boundaries The proposed project includes the entire Promise Zone boundary and other communities The proposed project includes a portion of the Promise Zone boundary The proposed project is outside of the Promise Zone boundaries, but specific and definable services or benefits will be delivered within the Promise Zone or to Promise Zone residents

Please note that projects which substantially and directly benefit Promise Zone residents but which are not within the boundaries of the Promise Zone may be considered. Agencies will make clear the acceptable definition of substantially and directly beneficial in the program’s award and funding announcement.

I further certify that:

(1) The applicant is engaged in activities, that in consultation with the Promise Zone designee, further the purposes of the Promise Zones initiative; and

(2) The applicant’s proposed activities either directly reflect the goals of the Promise Zone or will result in the delivery of services that are consistent with the goals of the Promise Zones initiative; and

(3) The applicant has committed to maintain an on-going relationship with the Promise Zone designee for the purposes of being part of the implementation processes in the designated area.

Name of the Promise Zone Official authorized to certify the project meets the above criteria to receive bonus points:

Title:

Organization:

Signature:

Date (mm/dd/yyyy)