Thank you for your interest in the 2017 New Bedford HSPN Point in Time Count. The Count will occur on Wednesday, January 25th at 2pm until Thursday, January 26th at 2pm. We are asking all of our volunteers to complete the following brief registration form. We will follow up with you in the near future with more logistical information. Thank you for your participation.

* 1. What is your first name?

* 2. What is your last name?

* 3. What is your Organizational Affiliation?

* 4. What is your best contact phone number?

* 5. What is your best email address?

* 6. Have you participated in the Street Count before?

* 7. The Count will start on Wednesday, January29th at 2pm and conclude on Thursday, January 30th
What hours are you available to participate in the count? (Check all that apply)

* 8. The Street Count utilizes a variety of methods to collect data. Please check off all that you are interested in:

* 9. Are you interested in being a team leader?

* 10. We are paying special attention this year on identifying homeless/unaccompanied youth. Do you have an interest in this population and/or do you have any contact, information or resources that can help with identifing this population