Fresno Madera Continuum of Care (FMCoC) - Lived Experience Representative Application
This application is NOT for housing or shelter. This is for the Lived Experience Representative Initiative within the Fresno Madera Continuum of Care (FMCoC). The FMCoC started a Lived Experience Advisory board (LEAB) in August 2022, to ensure the voices of people with lived experience shaped how the CoC designed and implemented an effective homelessness response system within Fresno and Madera Counties. This new Lived Experience Representative Initiative is a result of transitioning from the LEAB to a new model that incorporates people with lived experience into every part of the FMCoC's processes. Applicants who are picked to serve as CoC Lived Experience Representatives will be compensated for their time and work, according to the Stipend Policy.
Name
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First Name
Last Name
Pronouns
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Gender
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Please Select
Nonbinary
Woman
Man
Genderfluid
Two-Spirit
Age
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Race/Ethnicity
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Native American or Alaskan Native
Black or African America
Hispanic or Latino/é/a
Middle Eastern
Native Hawaiian or Pacific Islander
Asian
White
Decline to Answer
Phone Number
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-
Area Code
Phone Number
E-mail
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example@example.com
City You Reside In
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Are You Currently Experiencing Homelessness in Fresno County or Madera County?
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Yes
No
Have You Previously Experienced Homelessness in Fresno County or Madera County?
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Yes
No
In What City AND State Did You Experience Homelessness?
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When was your LAST episode of homelessness?
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I am currently experiencing homelessness
Less than 1 year ago
1-5 years ago
More than 5 years ago
Please Check if You Identify with Any of the Following
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Transitional Age Youth (18-25)
BIPOC
LGBQ+
Trans/Nonbinary/TGI
Survivor of Domestic or Intimate Partner Violence
Survivor of Human Trafficking
Seniors (60+)
Disabled
Criminal Legal System Involved
None of the Above
Why Are You Interested In Serving As a Lived Experience Representative?
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What Days & Times Are You Most Available?
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Mornings Only (8am-12pm)
Afternoon Only (1pm-5pm)
Evenings Only (after 5pm)
Any Times
Monday
Tuesday
Wednesday
Thursday
Friday
Check the Relevant Skills, Abilities or Experiences You Have
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Can Use Email
Ability to Attend Virtual Meetings
Public Speaking
Previous Outreach Experience
Interest or Ability to Read Policies and Procedures
Ability to Use Word, Excel, etc.
Abides by Confidentiality Agreements
Recent Experience at an Access Site
List Your Experience Relevant to the Role You Are Interested In, If Any:
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I Am Interested In Serving On This Initiative: (See Chart of Roles Above):
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POINT IN TIME COUNT WORKGROUP
COORDINATED ENTRY SYSTEM (CES) STANDING COMMITTEE
FUNDING INPUT
PSH APPEALS PANELS
PSH FORMS AND FEEDBACK FORM SUPPORT
TRAINING SUPPORT
OUTREACH
SPECIAL PROJECTS
FUNDING PANELS
OPEN TO ALL
UNSURE
Please Review the Stipend Policy below:
Please Review the Attendance Policy below:
Back
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Please Review the Code of Conduct & Conflict of Interest Policy
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I have read and understand that submitting an application means that I agree to abide by both the Conflict of Interest and Code of Conduct policies.
List Any Conflicts of Interest Below: This Includes Disclosing if You Are Employed or Contracted by a Service Provider or Board Member for a Nonprofit (If Not Applicable Enter N/A)
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I have read and understand the Roles, Descriptions, and Commitments for the Lived Experience Representative Initiative.
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I have read and understand the Stipend Policy.
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I have read and agree to abide by the Attendance Policy.
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I agree by checking this box I am signing electronically in agreement to abide by all policies and submit my application.
Read and write this below "I understand that this application is not for shelter. I understand this application is to be a Representative in the FMCoC."
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Signature
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Please verify that you are human
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Send
Send
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