Thank you for volunteering for Chicago's 2019 Homeless Count! 

If you have never participated before, the Chicago Department of Family & Support Services will soon be posting a short video to its website so that you know exactly what to expect. If you have any questions, please email homelesscount@cityofchicago.org.

By completing and submitting this form, you are confirming your attendance and participation on Thursday, January 24, 2019, between 9 PM through 3 AM.

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* 1. First Name:

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* 2. Last Name:

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* 3. Daytime phone number:

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* 4. Cell phone number:

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* 5. Are you age 18 or older? (Must be 18+ years of age to participate)

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* 6. What is your gender?

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* 7. Please provide an email address where we may contact you regarding the Homeless Count or site confirmation?

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* 8. Will you have a car available for use during the Homeless Count (not required)?

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* 9. If you have a car available, would you be willing to use your car for transportation of your volunteer team during the Homeless Count (not required)?

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* 10. Have you volunteered for previous Homeless Counts?

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* 11. Please select a location site.  You will report to this site by 9PM on January 24, 2019 and will return to the site with your team when finished. 

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* 12. Would you like to register as a group? Please make sure to register for the same location and provide the names of the other members of your team here. Please note that teams must be able to fit into a volunteer vehicle and the Site Leader has discretion on team assignments.

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* 13. Please provide any additional information that you would like to submit. (i.e. I am a Licensed Social Worker, I would like to be paired on a team with my colleague/friend/spouse, etc.)

BEFORE YOU SUBMIT: Please note that you will not be able to return to your responses after you submit. Please print or note which site you have chosen.  

Site assignment email confirmation will be sent to all volunteers no later than January
 11th, 2019.

If you have any questions or concerns, please email homelesscount@cityofchicago.org. Thank you for registering!

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