Black-, Indigenous-, People of Color-Owned Business Enterprises or Women-Owned Business Enterprises Qualification Form
Last Updated: January 2026
Instructions: This form is applicable for the HOME American Rescue Plan (HOME ARP) funding round. This Black-, Indigenous-, People of Color-Owned Business Enterprises or Women-Owned Business Enterprises Qualification Form can be used as documentation for projects claiming the selection criterion in the HOME ARP Self-Scoring Worksheet. The form must be completed by an authorized officer of the organization.
This form should be completed for each entity claiming the selection criterion. Minnesota Housing will not accept only one Qualification Form if more than one entity claims the selection criterion. See the HOME ARP Self-Scoring Worksheet for eligible entities and additional supporting documentation, if applicable.
Project Information
Project Name:      	Project D#:      
Business Enterprise Information
Business Enterprise Full Legal Name:      
Business Enterprise Street Address:      
Business Enterprise City, State ZIP Code:      
The business enterprise is a .
The business enterprise is the project’s (check all that apply):
	 Owner and Sponsor
	 Developer
	 Architect
	 General Contractor
	 Management Agent
	 Service Provider
	 Development Consultant
Individual Ownership Interest of a For-Profit Business Enterprise
Complete Table A if the business enterprise is a for-profit entity. If there are additional owners, beyond the number of rows included in Table A, replicate the table in a separate document and submit as supporting documentation for the selection criterion.
Table A: For-Profit Individual Ownership Interest
Name of Individual Owner	Black, Indigenous, or Person of Color or Woman	Ownership Interest %	
     		     	
     		     	
     		     	
     		     	
     		     	
Total	     	
The information included in the Table A verifies that the for-profit business enterprise is at least 51% owned by one or more individuals that are .
Nonprofit or Governmental Entities
The executive director or equivalent, of the  business enterprise is .

Certification
The undersigned hereby certifies that the information set forth herein, and in any attachments in support thereof, is true, correct, and complete to the best of my knowledge and belief.
     
Name of  Business Enterprise
     	     
Authorized Signatory Printed Name	Title
     	     
Authorized Signature	Date