Erie County Home Team Homeless and Housing Coalition
Request for Membership Form
Name
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Agency
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Position Held within Agency
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Address
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Phone
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Email
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List others you know of within your agency that are involved with this collaborative.
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Provide a brief statement regarding your interest and participation in the coalition.
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What attributes do you bring that could be of benefit to this collaborative?
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Please disclose any conflicts of interest that you may have that could impede in any decision making roles on this collaborative.
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