Forms & Applications

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Several forms are available for the Community Health Initiative, Construction Projects, Goods & Services, the Management & Technical Assistance Program for Nonprofits, and the Management Assistance Program for Small Businesses in Adobe Acrobat (.pdf) and Microsoft Word (.doc) formats.

Note: Download the FREE Acrobat Reader if you don't already have it. Acrobat Reader is needed to open and read PDF files.

To get the forms back to us quickly and efficiently, apply online or submit attachment via e-mail to bced@umn.edu, fax @ 612-625-9056 or by postal mail to: University of Minnesota, Office for Business & Community Economic Development, 2221 University Avenue SE, Suite 20136, Minneapolis, MN 55414.

 

Community Health Initiative (CHI) Forms

For Students

Community Internship Application

Students seeking an internship with a community-based nonprofit organization or small business that focus directly on addressing public health issues or health disparities in underserved communities.  Only full-time graduate and professional students in the Schools of Medicine, Public Health and Social Work are eligible to apply.

Click here for program details and participation requirements.

Online Application

Revised: 11/17/17

 

Student Consulting Project Application

Students seeking a consulting project with a community-based nonprofit organization or small business that focus directly on addressing public health issues or health disparities in underserved communities with building capacity and improving their overall performance.  All graduate and professional students enrolled at the Twin Cities campus are eligible to apply.

Click here for program details and participation requirements.

Online Applicaton

Revised: 11/17/17

 

For Organizations  

Application for Student Internship

Community-based nonprofit organizations or small businesses seeking an internship from a University of Minnesota graduate student. This Community Internship will assist organizations that focus directly on addressing public health issues or health disparities in underserved communities.

Click here for program details and participation requirements.

Revised: 11/17/17

Application for Student Consulting Project

Community-based nonprofit organizations or small businesses seeking consulting services from a University of Minnesota graduate student. This Student Consulting Project will assist organizations that focus directly on addressing public health issues or health disparities in underserved communities with building capacity and improving their overall performance.

Click here for program details and participation requirements.

Revised: 11/17/17

Construction Forms

Targeted Business & Community Development Questionnaire

Each Bidder must include Document TGB 658-A with their bid. Bidders who fail to include Document TGB 658-A with their bids will be deemed non-responsive and their bids will be rejected.

In the event a Bidder requires additional time to confirm TGB quotes for the project, they may FAX a “revised” copy of 658-A to the OBCED office within twenty-four hours of the bid opening date. All bids will be scored twenty-four hours after the bid opening date.

Information received after the twenty-four hour window will not be accepted.

Document 00658-A

Revised: 10/5/2018

 

Targeted Business List

Document 00658-B explains the scoring guidelines for the 658-A. Information on the 658-B is for the bidders use only and should not be returned.

Document 00658-B

Revised: 10/5/2018

 

Targeted Business & Community Development Questionnaire

Document 658-C

Revised: 10/5/2018

 

Monthly Employment Compliance Report

Document 00659 must be completed on a monthly basis and sent to the BCED Department for the duration of the project.

Document 659

Revised 5/15/2013

 

Targeted Business Total Payment Affidavit

Document 00660 shall be executed by the Prime Contractor after all work has been performed by the Targeted Businesses on the project. The signed affidavit can be submitted by U.S. mail or by FAX.

Document 660

Revised: 3/15/2013

 

Targeted Business Verification of Completed Work

Document 00661 is completed by the Targeted Business and verifies that at least 75% of the subcontracted TGB work was actually completed by the Targeted Business to whom it was contracted. The signed affidavit can be submitted by U.S. mail or by FAX.

Document 661

Revised: 3/15/2013

 

Goods & Services Forms

Prime Contractor Payment Verification Form (Non-Construction Only)

Upon being awarded a contract, RFP respondents who have committed to sub-contracting a portion of the value of the contract to a certified Targeted Business, will receive Document A. This document is to be submitted quarterly in order to remain in compliance with the contract. Please note: this document must be submitted no later than 10 business days after the end of the quarter.

Document A

Revised: 10/5/2018

Targeted Business Payment Verification

Upon being awarded a contract, RFP respondents who have committed to sub-contracting a portion of the value of the contract to a certified Targeted Business, will receive Document B. Document B is to be completed by the Targeted Business(es) who will be performing a portion of the work. In order to remain in compliance with the contract, prime contractors are responsible for submitting Documents A & B quarterly. Please note: this document must be submitted no later than 10 business days after the end of the quarter.

Document B

Revised 10/5/2018

Computer Donations Form

Upon being awarded a contract, RFP respondents who have committed to donating computers to the Technology Empowerment Center will receive Document C. This document is to be included in the shipment of any computers/laptops. 

Document C

Revised 10/5/2018

Funds Contribution Document 

Upon being awarded a contract, RFP respondents who have committed to contributing funds to one or more OBCED program must include Document D when mailing a check to OBCED. Funds contributions are to be fulfilled in one or two payments. 

Document D

Revised 10/5/2018

Please note: Failure to complete these forms in a timely manner will result in contractual non-compliance.

Management & Technical Assistance Program (MTAP) Forms

Organization Application

Community-based Nonprofit Organizations or small businesses who would like to receive technical assistance from student consultants that can help them improve operational, management and organizational effectiveness, enhance their overall performance and build capacity should complete this application.

Click here for program details and participation requirements.

Revised: 11/17/17

Student Application

Graduate and professional students who would like to work under the direction of the Office for Business & Community Economic Development to provide consulting services that help nonprofit organizations and small businesses improve their overall performance.

Click here for program details and participation requirements.

Revised: 11/17/17

WMBE Profile Form

The Targeted Business Directory is intended to increase the utilization of Targeted Businesses, business enterprises owned and operated by women, minority and/or disabled persons (WMDBEs).

Click here for details and listing requirements.

WMBE Profile Form

 

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