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Para tener esta encuesta en español, haga clic en el botón de inglés en la esquina superior derecha

Questions? Email Ashley Johnson, Senior Project Manager at Ashley.M.Johnson@Phila.gov.

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* 1. Email

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* 2. First Name

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* 3. Last Name

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* 4. Primary Phone Number

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* 5. Home Zip Code

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* 6. Organization/Affiliation (If no organization or affiliation, please respond with "Resident")

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* 7. Are you  interested in being a TEAM LEADER for the 2022 PIT Count? (Team Leaders can not be a first time volunteer due to serving in a leadership position guiding an assigned team)

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* 8. Are you interested in being a VOLUNTEER for the 2022 PIT Count?

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* 9. Are you interested in being a YOUTH GUIDE for the 2022 PIT Count? (Youth Guides serve in a leadership position and are between the ages of 18 - 24)

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* 10. What is your volunteer assignment preference? Check ONLY one.

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* 11. For City Staff and Outreach Workers: If you're interested in participating in the Observational Count, do you have a preferred zone/neighborhood you would like to cover?

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* 12. If you're interested in being a Physical volunteer, which shift would you prefer? Check all that apply.

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* 13. Is English your primary language?

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