Membership Form | The Coalition for the Homeless of Pasco County

Membership Form

Fields with * are required.

Organization:

Your name*:

Street address*:

City*:

State*:

Zip code*:

Phone number*:

Fax number:

E-mail address*:

Briefly describe how your organization serves the homeless and/or needy*:

Please check the appropriate type of membership*:

Individual ($25)Organization ($100)
Individuals who are currently homeless are encouraged to participate at no cost.

Coalition Committees (Please check one or more to join):

Acceptance*:
As a member of the coalition, for the purpose of participating in the development of the Continuum of Care (CoC) for Pasco County, as required for the response to the HUD Super NOFA, I understand that it is my obligation to actively participate in this coalition for a minimum of one year before and one year after the completion of the CoC. This will include active participation in CoC committees, year round work on refining the CoC and providing assistance in the next HUD Super NOFA process.

By checking this box I acknowledge that I agree to the statement above.

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