New CoC Member Application - No Dues Required

Pinellas CoC New Member Application (Individual or Organization)

Pinellas CoC New Membership (No Dues Required)

To renew an existing membership:www.pinellascoc.org/join

Name *

Title

First Name

Last Name

Phone *

Email *

Mailing Address *

Address Line 1

City

State

Zip

Organization (if applicable)

Job Title (if applicable)

Website (if applicable)

Pinellas County Affiliation *

I live in Pinellas County

I work in Pinellas County

My organization serves Pinellas County

Pinellas CoC members must live, work, or attend school in Pinellas County, or represent organizations that serve Pinellas County. Applicants that do not meet this criteria are ineligible for membership.

Have you experienced homelessness? *

Sliding Fee Scale of 100% available for:

Organizations with an annual operating budget under $250,000 or 2 or fewer full-time employees are eligible for 100% off membership dues. Organizations requesting a sliding fee scale are asked to submit a copy of their annual budget and/or organizational chart to confirm eligibility.

Membership Type (No Dues Required) *

More information can be found on membership benefits and levels here: www.pinellascoc.org/join

Documentation Upload

This applies only to those applying for membership levels of Grassroots Advocate, Faith-Based Partner, Government or Nonprofit Partner, or For-Profit Partner. "

Upload the documents that apply: *

Most recent 990 form or the organization's most recent audit

Current State of Florida (Sunbiz) Department of State certificate

501(c)(3) designation

Department of Agriculture Compliance Certification

Annual Budget and/or Organizational Chart