What is your full name?
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What is your preferred email address?
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What is your preferred phone number?
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(###)
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What is your residential zip code?
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Please list your current or most recent job title.
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Please indicate your current or most recent employer.
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Please indicate the number of years you have lived or worked in the neighborhood near the NMHC.
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To ensure representative committee membership, it is required that no less than 50% of the Advisory Committee membership be adult residents and or business owners of the neighborhood for at least two years with desired representation from the following:
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Please check all that apply
I represent a local business and/or foundation
I am a civic and/or faith leader with expertise in the provision of homeless services
I represent a behavioral health and/or healthcare provider
I represent an organization with expertise in workforce development or employment
I represent a school district, school board, or education-related provider
I represent a veterans services provider
I represent a city or state partner working to end homelessness
I represent the criminal justice system
I represent domestic violence/survivor provider of services
I represent the homeless subpopulation
I represent an underserved population (LGBTQ+, BIPOC, Lived Experience)
I have knowledge of issues pertaining to the community and/or persons experiencing homelessness
I represent a community organization: hospitals, universities, neighborhood groups, business or other entities that are impacted by or interact with people experiencing homelessness
I represent an agency that provides funding for providers of homeless services: represents local government, state agency, federal agency, foundation or other entity that funds homeless services programs or a Public Housing Authority or affordable housing developer
Other (please specify)
Please share why you are interested in participating it the NMHC Community Advisory Committee. (Limit 1000 characters)
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Given your interest/experience, what would you hope to be able to contribute as a member of the NMHC Community Advisory Committee? (Limit 1000 characters)
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To provide continuity of discussion and ensure that the community is represented by a broad number of interests, members of the Community Advisory Committee are expected to attend every meeting. If a Committee member misses three (3) consecutive meetings, the Committee shall consider the seat vacated. Do you agree to the attendance policy and intend to participate fully by attending Committee meetings?
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Yes
No