CoC APPLICATION | Changing Homelessness

Are you a New Member or Past Member?*

Past Member Since?*

Organization Name*

Website*

Name of Primary Representative*

This individual has the authority to vote on behalf of the organization when a coalition issue requires a membership vote

Name of Alternate Representative*

This person has the authority to vote in the absence of the primary representative

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Fax Number

Email*

Executive Director/CEO/President Name (if different)

Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Fax Number*

Email

Organization's Mission*

Organization's Annual Budget*

Services Provided*

How did you learn about the coalition?*

Membership Dues*

Please select the membership dues that aligns with your agencies annual budget

Document Checklist*

For this application to be considered for membership you must forward the following documents electronically to membership@changinghomelessness.org

Copy of Last Year's Annual Report
Copy of Most Recent 990 or Completed Audit
Copy of Operational Budget
List of Non-Profit Organizations in which the Agency is a Member (i.e. United Way)
Copy of Agency's 501(c)3 IRS Designation
Copy of Agency's State Tax Exemption Form
Copy of Reference Letters or Letters of support from Government Agencies
Copy of Agency's General Liability Policy

CoC MEMBERSHIP