Arkansas DOT DBE/ACDBE Personal Narrative Form

Arkansas DOT DBE/ACDBE Personal Narrative Form

Please fill out the required fields and review your information before submitting.
Overview

As mandated by the United States Department of Transportation’s (USDOT) Interim Final Rule, “Disadvantaged Business Enterprise Program and Disadvantaged Business Enterprise in Airport Concessions Program Implementation Modifications,” each individual who holds a DBE or ACDBE certification based on a presumption of race or gender must be reevaluated to participate in the DBE or ACDBE program.

To maintain your certification as a DBE/ACDBE firm, you will be required to submit a personal narrative that demonstrates individualized, specific instances of economic hardship, systemic barriers, and denied opportunities that impeded your progress or success in education, employment, or business, including obtaining financing on terms available to similarly situated, non-disadvantaged persons.

Your personal narrative must state how and to what extent the impediments caused you economic harm, including a full description of type and magnitude, and must establish that you are socially and economically disadvantaged relative to similarly situated non-disadvantaged individuals. Additionally, you must include a current Personal Net Worth statement and any other financial information you consider relevant.

Firms that do not submit the necessary information will remain ineligible for the DBE program until they submit the required documentation demonstrating DBE eligibility under the new standards.

Note: For more information, please refer to 49 CFR Part 26.

Note: This form is an OPTIONAL method of writing your personal narrative. Individuals may otherwise write their narrative not utilizing this form.

Note: Each qualifying individual of the firm must complete and submit a personal narrative and a personal net worth statement.

Note: If a section does not apply to you or your firm, then please enter N/A for each of the respective fields.

Should you have any questions, please contact DBE Supportive Services Specialist, Natasha Halbert, via email at DBE@ardot.gov or phone at 501-569-2259.
Section 1: Qualifying Individual Information
Full Name

First NameLast Name
Company Name
Title
Ownership Percentage
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Certification Type
Introduction
Section 2: Social and Economic Disadvantage
Describe your specific instances of economic hardship, systemic barriers, and/or denied opportunities experienced by you as an individual. These instances should not be based in whole or in part on race or sex. Additionally, these experiences should be based on those that occurred within American Society.

For reference: 49 CFR 26.67
Economic
Systemic Barriers
Denied Opportunities
Section 3: Social Impediment
Describe how the instance(s) described in the previous section impeded your progress or success in Education, Employment, or Business, including obtaining financing on terms available to similarly situated, non-disadvantaged persons.

Education – Factors such as denial of equal access, compared to all similarly situated persons, to institutions of higher education and vocational training, exclusion from social and professional association with students or teachers, denial of educational honors rightfully earned, and social patterns or pressures that discouraged the individual from pursuing a professional or business education.

Employment – Factors such as unequal treatment, compared to all similarly situated persons, in hiring, promotions, and other aspects of professional advancement, pay and fringe benefits, and other terms and conditions of employment; retaliatory behavior by an employer or labor union; and social patterns or pressures that have channeled the individual into non-professional or non-business fields; or,

Business History – Factors such as unequal access, compared to all similarly situated persons, to credit or capital, acquisition of credit or capital under commercially unfavorable circumstances, unequal treatment in opportunities for government contracts or other work, unequal treatment by potential customers and business associates, and exclusion from business or professional organizations. Other relevant evidence may be considered, but the incidents or experiences discussed in the narrative must not rely, in whole or in part, on race or sex.

For reference: 49 CFR 26.67(a)(1) | IFR FAQ Certification Reevaluation Q10
Education
Employment
Business History
Section 4: Economic Harm
Describe how and to what extent the impediments caused the owner economic harm, including a full description of the type and magnitude, and must establish that the owner is economically disadvantaged in fact relative to similarly situated non-disadvantaged individuals.

For reference: 49 CFR 26.67(a)(2)
What Happened
How It Impacted You
Type and Magnitude of Harm
Other Experiences
Personal Net Worth Statement & Supporting Documents
Please include any additional financial information you consider relevant, such as your most recently filed personal tax returns (including all schedules and W-2s), current personal bank statements, checking and/or savings account statements, IRA and/or brokerage account statements, mortgage account statements, and any other supporting financial documentation.

The federal PNW Statement form is available for download here: U.S. DOT Personal Net Worth Statement
Upload PNW Statement

Cancelof
Supporting Documents

Cancelof
Signature & Certification
Certification

By checking this box, you are agreeing that your statements are true, accurate, and are not based in whole or in part on race or sex. This optional form is a supplemental document to support eligibility requirements, and my signature acknowledges that completion does not establish qualification. Per the Code of Federal Regulations (49 CFR) the information contained in this form is part of a requirement for continued eligibility in the DBE and ACDBE programs. My signature below also constitutes my acknowledgement that, in the event any of the information contained on this form is determined to be inaccurate or misleading by the Arkansas Unified Certification Program, your firm's DBE and/or ACDBE certification may be decertified, or, in the case of a certification review, that the certification may be revoked.
Signature
Saving Your Progress

This form may take time to complete. If you need to step away, click the Save button to save your progress and return later without losing your work.

When you click Save, you will have two options:
- Email a link to yourself – A link to your saved progress will be sent to your email address so you can return and continue at any time.
- Copy the link – Copy the link directly to your clipboard to save for later.
Important: Saved progress that is not submitted within two months will be automatically deleted. Please make sure to complete and submit your form before that time.
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Arkansas DOT DBE/ACDBE Personal Narrative Form

Overview

Section 1: Qualifying Individual Information

Section 2: Social and Economic Disadvantage

Section 3: Social Impediment

Section 4: Economic Harm

Personal Net Worth Statement & Supporting Documents

Signature & Certification