Coordinated Entry Committee Application Survey

Community Resource and Referral Center Representative (Phoenix VA)
Individual representation from a CRRC/VA staff member who interacts with the Coordinated Entry System.

Regional Behavioral Health Authority Representative
Individual representation from the Maricopa Regional Behavioral Health Authority.

Domestic Violence Provider Representative
Individual representing an agency that provides services and specializes in care for victims of Domestic Violence.

Funder Representative
Individual representing a public or private entity that provides funding for homelessness services in Maricopa County.

Youth Provider Representative
Individual representative from an agency with a current MOU with Coordinated Entry that services and specializes in care for individuals under the age of 25.

Families Provider Representative
Individual representative from an agency with a current MOU with Coordinated Entry that services individuals with children under 18.

Singles Provider Representative
Individual representative from an agency with a current MOU with Coordinated Entry that services individuals without children.

HMIS Representative
Individual representatives from the COC designated Homeless Management Information System (HMIS) Lead agency.

CoC Board Member
Individual representatives from a current member of the CoC Board.

Jails Representative
Individual representative from the County Jail system.

Access Point Representative
Individual representative from an agency with a current MOU with Coordinated Entry that is designated as an Access Point.

Coordinated Entry Leads
Individual representatives from the COC designated Coordinated Entry Lead agencies.

ESG Recipient
Individual representing an ESG recipient in Maricopa County.

Community Member
Individual representing relevant agencies with a connection to homelessness services and knowledge of Coordinated Entry. Including but not limited to, representatives from public housing authorities, universities, jails/re-entry programs, hospitals, businesses, non-profit organizations, or others as applicable.

CoC or Community Stakeholder with Coordinated Entry background
Individual representing relevant agencies with a connection to homelessness services and knowledge of Coordinated Entry. Including but not limited to, representatives from public housing authorities, universities, jails/re-entry programs, hospitals, businesses, non-profit organizations, or other as applicable.

Lived Experience Representative
Individual representation of those who have been homeless or are currently experiencing homelessness.

Coordinated Entry Committee Application

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* 1. Please enter contact information below:

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* 2. Please select all categories that apply:

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* 3. Please select the area(s) you represent: