Work with LEAB

Name*

First Last

Have you ever experienced homelessness, either in the past or currently?*

What skills, experiences, or perspectives would you contribute as a member of the Lived Experience Advisory Board?*

Are there any particular issues you are interested in working on as part of the Board? Why are you interested in becoming a member of the Board?*

Please list one personal reference we can contact – Name*

First Last

Reference Relationship*

Relationship Phone*

Board membership ideally represents the diversity of experiences of those who have lived homelessness in Santa Clara County.

If you’d like, please let us know which, if any, of the following groups you identify with

we are aiming to build a diverse and inclusive Board

Specify Other*

What housing and shelter services have you utilized in Santa Clara County, if any?

Please let us know names of programs and agencies if you are able to do so, and include shelters, permanent housing, and services.

Contact Information

Please fill in all that you can

Email Address

Address where you can receive mail

Street Address Address Line 2 City State ZIP Code

Phone where you can receive messages

Any alternate or preferred contacts

Name

This field is for validation purposes and should be left unchanged.