Individual Membership Application

General Collaborative Membership - Individual

Individual Active Level Membership Application

* Indicates required field

Name: *

First

Last

Email Address: *

Phone Number *

Mailing Address: *

Line 1

Line 2

City

State

Zip Code

Country

Most recent TCCoC Meeting attended: *

Are you affiliated with any local organization that is currently part of TCCoC membership, or may consider seeking membership in the future? *

No, I represent my own interests, as an individual, exclusively. Yes (Please explain below) I'm not sure (Please explain below)

If you responded "Yes" or "Unsure" above, please describe your affiliation to TCCoC Member Organization(s): *

If you are affiliated with any TCCoC Organizational Members, it may not be appropriate for you to become a voting member of the TCCoC General Collaborative. However, your attendance at General Collaborative meetings as an Open Level member is always welcome and encouraged.

If you are affiliated with an organization that may wish to join TCCoC at the organizational level, please discuss your interest in becoming a voting member with your organization's leadership to determine the appropriate type of membership for you. To apply for membership as a representative of any organization, please secure authorization from your organization's leadership, then complete and submit a TCCoC General Collaborative Application for Organizations instead of this form.

Please check all that apply to you: *

Formerly Homeless Currently Homeless Local Business Owner/Manager

What prompted you to seek TCCoC membership? *

Briefly describe you hope to contribute and/or gain from working with TCCoC: *

Tehama County Continuum of Care's Code of Conduct/Conflict of Interest Policy:
At any time, an issue or matter may come before the Continuum for which a Member may have a conflict of interest, (s)he shall abstain from voting on said issue or matter. The Member may still participate in the discussion if they fully disclose the nature of their conflict of interest and the majority of the Members present vote to allow their participation. Any Member with a conflict of interest may still answer questions posed by another Member during the discussion.

I agree to observe the Tehama County Continuum of Care General Collaborative's Code of Conduct/Conflict of Interest Policy. *

Agree

Submit

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