Nomination Form People with Lived Experience in Homelessness

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* 1. Your Full Name

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* 2. Your Email Address

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* 3. Your Phone Number

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* 4. Are you the case manager of the nominee?

Yes

N/A

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* 5. Full Name of Nominee

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* 6. Nominee Email Address, if applicable

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* 7. Nominee Phone Number, if applicable

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* 8. Best method of contact

Phone call

Text

Please enter email or phone number (cell phone if requesting text).

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* 9. What is the preferred time to contact nominee?

9:00 am - 12:00 pm (noon)

12:00 (noon) - 3:00 pm

3:00 pm - 6:00 pm

6:00 pm - 8:00 pm

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* 10. Select the timeframe in which this person has experienced homelessness or some other housing crisis.

Currently

Within the last 7 years

8 or more years ago

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* 11. Has this person navigated the Out-Wayne County homeless response system or attempted to access our Coordinated Entry system?

Yes

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* 12. What housing program was this person enrolled in?

Permanent Supportive Housing

Rapid Rehousing

Emergency Response Shelter

PATH/Street Outreach

Supportive Services for Veteran Families

Safe Haven

Transitional Housing

N/A

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* 13. Is the nominee a Wayne Metro employee or employee of a CoC funder agency (this will not hinder their chances for participation in the program)?

Yes

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* 14. The Out Wayne County CoC is in the process of creating a youth advisory board. Is the nominee between the ages of 16-24?

Yes

Nomination Form People with Lived Experience in Homelessness

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* 1. Your Full Name

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* 2. Your Email Address

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* 3. Your Phone Number

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* 4. Are you the case manager of the nominee?

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* 5. Full Name of Nominee

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* 6. Nominee Email Address, if applicable

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* 7. Nominee Phone Number, if applicable

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* 8. Best method of contact

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* 9. What is the preferred time to contact nominee?

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* 10. Select the timeframe in which this person has experienced homelessness or some other housing crisis.

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* 11. Has this person navigated the Out-Wayne County homeless response system or attempted to access our Coordinated Entry system?

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* 12. What housing program was this person enrolled in?

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* 13. Is the nominee a Wayne Metro employee or employee of a CoC funder agency (this will not hinder their chances for participation in the program)?

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* 14. The Out Wayne County CoC is in the process of creating a youth advisory board. Is the nominee between the ages of 16-24?

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* 15. In 100 words or less, please describe why this person would be a great fit for the CSBG-D Innovation Initiative?