Atlanta Continuum of Care Membership Survey

Thank you for your interest in joining the Atlanta CoC! Please fill out the information below:

Question Title

* 1. Contact Information:

First and Last Name

Agency/Organization

Agency/Organization Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Would you like to be on the CoC email list? This includes a monthly newsletter and other important announcements.

Yes

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* 3. Please select the most accurate description for your agency:

Homeless Services Provider

Mainstream Service Provider

Other Service Provider

Other Non-profit

Local Government

State Government

Private Funder

Other:

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* 4. If applicable, what types of services does your agency provide?

Emergency Shelter

Transitional Housing

Rapid Rehousing

Permanent Supportive Housing

Prevention Services

Subsidized Housing

Supportive Services

Other (please specify)

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* 5. If you agency provides supportive services, please list them here:

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* 6. Is your agency active on ClientTrack, the designated Homeless Management Information System (HMIS) for the Atlanta CoC?

Yes

No, because we are a certified domestic violence provider

Other

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* 7. Have you or someone from your agency attended an Atlanta CoC meeting within the last 12 months?

Yes

Other

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* 8. Are you the designated voting member for your agency?

Yes

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* 9. If no, please provide the contact information for the voting member:

Name

Email Address

Phone Number

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* 10. I support the goals of the Atlanta CoC and agree that by working together, we can make homelessness rare, brief, and nonrecurring in Atlanta.

Agree

Disagree

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* 11. Please use the space below to provide any feedback about your experiences with the CoC. Or, use the space to give some suggestions on what Partners for HOME can do to make the CoC more effective.