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AHAC Nominee Form

This form is to be completed by the Affordable Housing Advisory Council (AHAC) Nominee. Submit this form after the Nominator Form has been submitted. Both forms must be submitted by November 17, 2023.

If you need assistance with the AHAC Nominee or Nominator Form please email Kylie Mergen, director of Housing and Community Development, or call 785.478.8056, if you have questions.

Please Note: Employees, directors or individuals serving FHLBank's members in a voluntary capacity are not eligible to serve on the AHAC. To increase the diversity of experience on the AHAC, FHLBank is seeking nominees with community lending and economic development expertise in addition to expertise with affordable housing.

Nominee Name
Nominee Address
Nominee Contact Information
Nominee Employer Information
Nominee Employer Contact Information
Nominee’s Major Responsibilities at Employer
Nominee’s Resume required, accepted file types: docx, pdf
long-file-name-here.docx 100% close
Are you an employee of or on the board of directors of or have any involvement with an FHLBank Topeka member financial institution?
Have you, your employer, or an organization with which you were associated ever participated in FHLBank Topeka’s Affordable Housing Program or Homeownership Set-aside Program?
If “Yes,” select the programs in which you, your employer, or an organization with which you were associated participated.
I certify I have never been convicted of a felony.
I certify I have not violated any federal or state civil laws relating to the securities, banking, housing or real estate industries.
I certify that I have not had a professional license suspended or revoked.
If you answered "False" to any of the questions above, please explain.
By signing this form, I understand appointment to FHLBank Topeka’s Affordable Housing Advisory Council may be conditioned upon the results of a background check.*
Submit this completed form no later than November 17, 2023.
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