G-L-C CoC Membership Form - New & Renewal

To become a member of the Gaston-Lincoln-Cleveland Continuum of Care, (or renewal a current membership) please read the following information carefully and then complete and submit this form in its entirety. There are two parts to the form: 1) Membership Information and 2) Code of Conduct & Conflicts of Interest Disclosure. Incomplete forms will not be processed. See item #3 below about the attendance requirement for membership. Once all requirements are met the membership application can be reviewed for approval. Non-members are welcome to attend G-L-C CoC Members meetings and all public G-L-C CoC activities and events, but non-members do not have a vote. Governance Committee meetings are open to all who wish to attend as observers (pre-registration may be required) - see dates and times for meetings by clicking on the Calendar tab on our website www.GLCImpact.com.

Membership Information
  1. Membership is open to all organizations and individuals committed to preventing and ending homelessness in the geographical region served by the Gaston-Lincoln-Cleveland Continuum of Care.
  2. This G-L-C CoC Membership Form must be completed to be considered. The CoC Lead Agency will process all membership forms and provide a response. Should there be any questions or concerns related to a membership request, the Lead Agency will forward the form to the G-L-C CoC Governance Committee for a final decision.
  3. Membership can be requested following attendance of at least one of the quarterly G-L-C CoC Members meetings.
  4. Active membership requires at least 50% attendance at quarterly G-L-C CoC Members meetings and active participation on at least one committee, sub-committee, or ad-hoc committee each operational year (July 1 - June 30).
  5. CoC voting privileges are contingent upon active membership.
  6. Members are expected to disclose any and all conflicts of interest and, when appropriate, recuse themselves from discussions and/or voting. Members are required to annually read and sign the G-L-C CoC Code of Conduct policy.
  7. One membership equals one vote.
  8. The use of proxies is not allowed.
  9. To maximize participation in the CoC and to provide opportunities for individual stakeholders to fully participate, there are two types of membership: Organizational & Individual.
    • Organizational Members may designate up to 3 persons annually who are authorized to represent the organization and, therefore, vote on behalf of the organization. Other persons from the organization may participate in CoC activities and meetings, including participation on committees, sub-committees, and ad-hoc committees (but may not serve on the Governance Committee). Regardless of the number of participants from an organization, each organization holds only one vote. An authorized representative must have sufficient authority to speak and vote on behalf of the organization. A person may only represent one organization.
    • Individual Members may not designate additional persons to represent them. Individuals who have a recognized role in a member organization (such as employee, board member, contractor, or consultant) may become individual members but may not vote.
  10. Membership must be renewed annually by submitting this form. To avoid disruption in membership (losing recognition as a voting member) renewals must be completed between June 15 - July 15 each year.
  11. Meeting attendance is documented for membership determination and regional CoC grant efforts.
  12. Any concerns or conflicts regarding CoC membership should be directed to the Lead Agency by email at engage@GLCImpact.com and will be decided by the G-L-C CoC Governance Committee. All decisions of the Governance Committee are final.
  13. Additional information and policies related to participation in the G-L-C CoC can be found on the CoC's website at www.GLCImpact.com. Go to the About page and scroll down to the G-L-C CoC Resource Library.

When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.
Special accommodations in completing this form can be requested by email at engage@GLCImpact.com or clicking on the Contact tab at www.GLCImpact.com and completing the contact form.
By typing your name below, you acknowledge the above statement.
4. Membership Type(Required)
5. Status of membership(Required)
New members are those individuals and organizations that were not on the G-L-C CoC's membership roster during the previous operating year. The CoC's operating year runs from July 1st - June 30th - Please only mark one.
For Organizations, this is the name of the Authorized Representative
If applying as an individual member, please enter "individual"
Enter the name of the organization you represent. If you are not associated with an organization enter "None"
For Organizations, please briefly describe your service area(s), services offered, and populations served.

For Individuals, please briefly describe why you want to be a member of the CoC.
10. Which G-L-C CoC Counties do you serve/represent?(Required)
For Organizations, please indicate within which counties you provide services.

For Individuals, please indicate within which counties you reside, work, or volunteer.

Mark only one option.
11. Please select the best description(Required)
Mark only one option

Please enter using this format: xxx-xxx-xxxx
If not applicable, enter "N/A"
(Applicable only to Organizations; otherwise enter "None")
(Applicable only to Organizations; otherwise enter "None")
I hereby apply for membership in the Gaston-Lincoln-Cleveland Continuum of Care and agree to abide by the Continuum of Care Governance Charter and terms of membership. By typing your full name in the space below you are acknowledging agreement with the terms and conditions provided in this membership form and attest that all of the information provided in this form is complete and accurate. You further agree to complete all additional information required of members including, but not limited to, identifying any conflicts of interest and abiding by the CoC's Code of Conduct. Please note: your membership approval or renewal will not be complete until you complete and acknowledge section 2 of this form.
18. G-L-C CoC Code of Conduct Policy & Conflicts of Interest Disclosure
The standard of behavior for the Gaston-Lincoln-Cleveland Continuum of Care (G-L-C CoC) is that all members scrupulously avoid any conflict between their personal, professional, and business interests and the interests of G-L-C CoC. This includes avoiding actual conflicts of interest as well as perceptions of conflicts of interest. This policy is to also set a professional behavior expectation when working within the capacity of the G-L-C CoC. The purposes of this policy are to:
  • comply with the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 and the Continuum of Care Program, Interim Final Rule (24 CFR Part 578),
  • protect the integrity of G-L-C CoC decision-making process,
  • enable our constituencies to have confidence in our integrity, and
  • safeguard the integrity and reputation of G-L-C CoC members.
Upon joining the G-L-C CoC, members submit a full written disclosure of their interests, relationships, and holdings that could potentially result in a conflict of interest. This written disclosure will be kept on file and updated annually. The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 requires G-L-C CoC members to disclose any conflicts of interests that arise in the course of meetings or activities. These include transactions, discussions, or decisions in which members (or their business or other nonprofit affiliations), their families and/or significant others, employers, or close associates will receive a benefit or gain. Members also disclose any family relationship, either by consanguinity or marriage, between themselvesand a committee member of G-L-C CoC who will be directly affected by a transaction or decision. After disclosure, members recuse themselves from participating in the transaction, discussion, and/or decision.

The G-L-C CoC requires all members conduct themselves according to the highest standards of ethics, integrity and behavior when dealing with colleagues, community and stakeholders.

All members are expected to:
  • participate in accordance with the Governance Charter guidelines,
  • refrain from any discriminatory, bullying or harassing behavior toward others,
  • not make any statements to the media about the G-L-C CoC and its business, unless expressly authorized to do so by the G-L-C CoC Governance Committee Chair, Vice Chair or Collaborative Applicant Lead Agency – Media statements should be referred to the above mentioned, and
  • refrain from sharing confidential information about individuals and families served through the G-L-C CoC without consent from the individual/family.
Any member(s) not upholding the standard set by the G-L-C CoC will have their membership in the G-L-C CoC terminated. This policy is meant to be a supplement to good judgment –G-L-C CoC members will respect its spirit as well as its wording.
19. I have read and understand the Code of Conduct & Conflicts of Interest Policy(Required)
Please disclose any other employment, business, or financial interest which you, a member of your organization, or any immediate family member (yours ormember of your organization) may have as an officer, director, trustee, partner, employee, or agent which might give a rise to a possible conflict of interest with NC 509 G-L-C CoC.
Please disclose all official positions which you, a member of your organization, or any immediate family member (yours or member of your organization) may have as a director, trustee, or officer of any charitable, civic, or community organization as well as any unofficial roles such as significant donor, volunteer, advocate, or advisor which might give rise to a possible conflict of interest with NC 509 GLC.
Please disclose any additional real, perceived, or potential conflict(s) of interest not covered above.
REMINDER: If at any time there is a matter under consideration that may constitute a direct or indirect conflict of interest not listed on this form, it is your obligation to disclose the matter to the Lead Agency and/or Governance Committee.

By typing your full name in the space below you are acknowledging agreement with the terms and conditions provided in this Code of Conduct Policy& Conflict(s) of Interest Disclosure form and attest that all of the information provided in this form is complete and accurate. You further agree to complete all additional information required of members as set forth in the G-L-C CoC Governance Charter.

I do hereby affirm that I have received and read the policy and will adhere to the document’s spirit, principles, and practices.

Please enter Full Name below: