CoC Membership Form

Lake County Coalition for the Homeless Membership Application

May 1st, 2026 to April 30th, 2027
Both new and current members are required to complete and submit a new form each fiscal year.

*This is not an application for housing*
Please indicate if this is a New Membership application or a Renewal Membership application

New MembershipRenewal Membership
Please specify the membership type that you are applying for:*

Full Membership is available to any incorporated non-profit organization or governmental entity. A Full Member pays $250 in dues, receives meeting notices, attends meetings, participates in discussions, and has one vote. Any homeless or formerly homeless persons attending Coalition meetings shall have one vote. These members shall be exempt from paying dues.Lived Experience Full Membership is available to any individual with lived experience of homelessness. All unhoused and formerly unhoused persons attending Coalition meetings shall be considered separately as one "Full Member" of the coalition and shall have one vote each. Lived experience Members shall be exempt from paying dues.Associate Membership is available to any individual who is not affiliated with a Full Member and who supports the Continuum OR supports the Continuum in a technical capacity. Associate Members do NOT pay dues and receive meeting notices and may attend meetings and participate in discussions. They do not have a right to vote.
Name of Entity*
Entity Type*

Nonprofit OrganizationBusinessIndividual
Please briefly describe why you are interested in this work and any additional information you feel is relevant to your application:
Address (if applicable):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Contact/ Designated Voter Name*

First NameLast Name
Title (if applicable):
Phone Number (if applicable):

Area CodePhone Number
E-mail (if applicable):
Secondary Contact/Alternate Name
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Committee Membership

The committees of the Homeless Coalition are crucial to its work. Participation on a committee is a requirement of membership.
Please indicate your committee interest below:*

Strategic Planning & System Performance Committee – Nestor Sagan This committee oversees the strategic planning process of the Coalition, analyzes trends and data, and makes recommendations on allocation of resources irrespective of particular projects.Homeless Management Information System (HMIS) Committee - Karina Galindo This committee oversees the Homeless Management Information System (HMIS) for the Continuum of Care.Monitoring & Project Performance Committee - Gregorio Resendiz This committee reviews projects funded by the Continuum of Care, Emergency Solutions Grant, or other related projects for compliance, appropriateness, and performance, as well as makes recommendations on allocation of resources specific to particular projects.System Coordination & Entry Committee – Stephani Schlappi This committee provides oversight of the coordinated entry process for the Coalition as well as coordination with other systems that may discharge people into homelessness.Community Engagement, Advocacy and Membership Committee – Jason Lenzi This committee is responsible for external and community relations, as well as membership management and elections.
Should be Empty:

Lake County Coalition for the Homeless Membership Application

Both new and current members are required to complete and submit a new form each fiscal year.

Committee Membership