Continuum of Care Membership Application

The Maricopa Regional Continuum of Care is seeking new members to fill vacancies on the Data Collaborative. Each year, the expertise of the Continuum of Care and community partners has resulted in more people being housed and supported in their quest for stability through the national Continuum of Care funding provided by the U.S. Department of Housing and Urban Development (HUD). The following questions will be reviewed by the Data Collaborative membership workgroup, but will otherwise be kept confidential. The information helps to ensure a diverse array of stakeholders and partners.

Question Title

* Contact Information

Name

Organization

Title

Email Address

Phone Number

Question Title

* Geographic Representation (select all that apply):

I represent an agency that serves individuals or families in the West Valley.

I represent an agency that serves individuals or families in the Central Valley.

I represent an agency that serves individuals or families in the East Valley.

I represent an agency that serves individuals or families across the entire Maricopa Regional CoC.

I represent an agency that serves Tribal land.

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* Racial Diversity - I consider myself:

White

Black

Native American

Asian- Pacific Islander

Multi-racial

Other (please specify)

Prefer not to respond

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* Ethnic Diversity - I consider myself:

Hispanic or Latino

Not Hispanic or Latino

Prefer not to respond

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* Underrepresented Groups - Please select all categories that you identify as:

Person with a disability

Trans / gender non-conforming / non-binary / two-spirit

LGBTQIA+

Veteran

Immigrant

Member of a tribal nation

None of the above