1. The U.S. Department of Treasury will be providing a self-certification form.
Have you self-certified?
If not, do you plan on self-certifying?
2. Do you represent any of the following? (Choose all that apply.)
Real Estate Company Local Government Investor Fund Manager Entrepreneur / Business Owner Anchor Institution Property Developer Philanthropy
If other, please describe
3. Investor / Opportunity Fund
Key Contact Last Name
Key Contact First Name
Key Contact Email Address
Key Contact Phone Number
4. Identify which tracts you want to invest in. (Choose all that apply.)
Urban Rural Suburban
5. Identify what topography / district you want to invest in. (Choose all that apply.)
Anchor Innovation Industrial Airport / Seaport Residential Other
6. List the communities or regions you plan on investing in. ( See the Michigan Prosperity Regions Map)
7. How do you plan to engage in Opportunity Zones (OZs)? (Choose all that apply.)
As an Opportunity Fund (OF) Manager (I plan to create an OF.) As a Project Sponsor (I own land, commercial property, or a business located in a designated OZ in Michigan and would like to receive investment from OFs.) As an Intermediary (I plan to provide professional service; e.g., legal, financial consulting to fund managers.) As an Investor (I would like to invest in an OF.) As a Community Stakeholder (I am a community leader, resident, or other stakeholder with ideas to share.) Other
8. What types of projects are you interested in? (Choose all that apply.)
Attainable Workforce Rental Low Income Housing Tax Credits Multi-Family Market Rate
Transit-Oriented Development Transit Service Improvements Road Improvements New or Improved Pedestrian or Bicycle Facilities Airport Connections or Services
Brownfield Redevelopment Coastal Zone Management Community Pollution Prevention
Other, please describe
9. Will you need trained employees?
10. If you have a specific project in mind, briefly describe:
11. Is there additional information you should provide for us to better ascertain which agency to refer you?
12. Will your project create long term jobs?
13. Will your project expand a business?
14. Will your project create a new business?
Disclaimer: The contact information you share on this form is not for public use unless we contact you for permission.
Michigan Opportunity Zone Referral Form Contact: If you have questions about this form, please contact Karen Gagnon, Policy Advisor, Michigan State Housing Development Authority,
MSHDAemail@example.com or (517) 241-3203.