NHC Providers and Stakeholders Association Member Agreement
As a member of the Northlake Homeless Coalition (NHC) Providers and Stakeholders Association, I agree to support the goals of the Continuum of Care (CoC).

I. I agree to regularly attend the NHC Providers and Stakeholders Association meetings or to send a representative of my organization (if applicable).

II. I understand that the United States Department of Housing and Urban Development (HUD) has established initiatives to end homelessness for the populations of Chronically Homeless, Families and Children, Veterans, and Youth. I agree to support these initiatives.

III. I agree to support the efforts of the NHC as the HUD Collaborative Applicant and its responsibility to carry out the HUD regulations and required initiatives, including but not limited to, the annual funding application, the Coordinated Access and Assessment System (CAAS), annual Point-In-Time counts, etc.

IV. I agree to comply with requirements for the collection and reporting of data that will help secure funding and to provide coordinated services to those affected by homelessness. These efforts include:
-- Census: enumeration of homeless individuals and families through focus groups, shelter counts, street counts and other efforts;
-- Needs Assessment: evaluation of the needs of homeless individuals and families and the sub-population categories into which they fall;
-- Assessment of resources: evaluation of the numbers and kinds of beds and other services available to serve homeless individuals and families;
-- Coordinated Access and Assessment System (CAAS) System: coordinated entry system promoting access to HUD-funded homeless assistance, assessment of client needs and prioritization of community resources appropriate to meet the needs of homeless individuals and families;
-- Homeless Management Information System (HMIS): I understand that if I am an employee of an agency that is a HUD-funded direct service provider to homeless persons that HUD has mandated the use of HMIS for data collection. Agencies that meet the VAWA definition of Domestic Violence Service provider are prohibited from entering client data directly into HMIS but are required to provide aggregate data and a comparable data system.
-- Mainstream Resources: HUD has mandated that homeless individuals and families be referred to mainstream resources including, but not limited to Medicaid, State Children's Heath Insurance Program (SCHIP), TANF, Food Stamps, SSI, Workforce Investment Act, and Veterans Health Care; and that referral, access and utilization of these resources be tracked in HMIS for each person.

V. I understand that the only requirement for membership is an interest in ending and preventing homelessness. I understand that this membership agreement is required to be considered a voting member of the Northlake Homeless Coalition Providers and Stakeholders Association. I understand that there can only be one voting member per organization (if applicable).

Note: This membership agreement is valid through December 31, 2019.

Email address *
Name *
Your answer
Organization *
Your answer
Mailing Address *
Your answer
Phone Number *
Your answer
Electronic Signature *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms