Continuum of Care Membership Application

Membership in the Guilford Continuum of Care (CoC) ensures community-wide commitment to preventing and ending homelessness and is open to organizations and individuals representing the entire geographic area covered by the Guilford CoC.

Members must be willing to assist and improve the lives of people who are experiencing homelessness as well as prevent and end the condition of homelessness.

Recognition as a voting member of the CoC allows participation in the overall strategy and direction for ending homelessness in Guilford. Members are listed on the CoC website, have opportunities for funding, receive biweekly newsletters, and have access to training opportunities. There are no dues or membership fees associated with Continuum of Care membership.

Members of the Continuum of Care will retain their membership and voting status as long as they are in good standing. To remain in good standing, Voting Members must attend 75% of the regularly scheduled meetings within a calendar year. Attendance at meetings is tracked on an individual basis, not at the agency/organization level. Voting Members must attend 75% of the regularly scheduled Membership Meetings within a calendar year.

Membership Applications are accepted throughout the year. Applications will be reviewed and evaluated by the Membership Committee, voted on by the Board of Directors, and voted on by the Continuum of Care Membership. Once approved, new members will participate in New Member Orientation, which is held virtually on the fourth Friday of each month.

NOTE: Voting membership also requires execution of Annual Conflict of Interest Disclosure Statement

Applicant Information

I am applying for membership with the CoC at the following level: Value is not selected

Name of Organization or Individual

Mailing Address

Address line 2

City

State Value is not selected

Zip

Physical Address

Address line 2

City

State Value is not selected

Zip

Main Phone

Fax

Website

Primary Geographic Area Served by Organization or Individual

Mission/Purpose of Organization or Individual

Population(s) Served by Organization or Individual

Type of Organization or Entity (click and select all that apply) Values are not selected

What services and/or programs do you offer as an organization or individual?

President / Executive Director

First Name

Last Name

Phone Number

Email

Current Board Chair

First name

Last Name

Phone Number

Email

Voting Representatives

Each member may name up to two (2) voting representatives. Only one (1) representative of an agency/organization may cast a vote on each action. In the event that neither representative can attend a duly called meeting, he or she may, with prior notice to the Chair, designate a proxy. Designations of proxies to conduct business should be rare. If a Continuum of Care voting member is unable to routinely conduct business, the agency/organization should seek to assign representation to another individual.

Voting Representative #1

First Name

Last Name

Representative Title

Email

Phone

Voting Representative #2

First Name

Last Name

Representative Title

Email

Phone

CoC Committees and Workgroups

Please select the committee(s) and/or workgroup(s) in which you would be interested in serving. Click HERE to learn more about each committee.

Select Committee(s) and/or workgroup(s) (click and select all that apply) Values are not selected

Conflict of Interest Disclosure Policy

ACKNOWLEDGMENT AND DISCLOSURE STATEMENT

The undersigned person, who has been appointed or elected to serve the Guilford County Continuum of Care in the capacity reflected below, hereby confirms that the undersigned has read and does understand the Guilford County Continuum of Care’s Conflict of Interest Policy as outlined in the Guilford County Continuum of Care Governance Charter and has received a copy of that Charter for present and future reference.

The undersigned agrees to take appropriate action with respect thereto, including initiative in disclosing activities, interests, or relationships wherever an actual or potential conflict of interest may exist, and to otherwise comply in all respects with the Conflicts of Interest Policy.

Consistent with the foregoing, the undersigned makes the following disclosure of any and all Interests as defined in the Conflicts of Interest Policy, in accordance with applicable reporting responsibilities (if none, please write “NONE”):

Disclosed Interests

First Name

Last Name

Position

Applicant Email

Date

Signature

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Click here to access the application.

Continuum of Care Membership Application

Applicant Information

President / Executive Director

Current Board Chair

Voting Representatives

CoC Committees and Workgroups

Conflict of Interest Disclosure Policy