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Privacy Notice:
Information provided in this survey is considered a public record and may be subject to public disclosure. For more information, see the Public Records Act, RCW Chapter 42.56. To learn more about how we manage your information, see our Privacy Statement
 
Please complete the short questionnaire below. Before completing the form, please check if you live in an eligible property. If you need a replacement card, please call or text (206)256-6722 or email ORCAOpportunity@seattle.gov. 

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* 1. 您的姓名是什麼?

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* 2. What is your t-code? (It's on your rent statement)

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* 3. 您的地址是什麼?

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* 4. 您目前是 SHA Transit Pass 公交卡計畫的參與者嗎? (即您目前是否有收到 SHA 提供的免費 ORCA 卡?)

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* 6. 您的出生日期是何時?

Date

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* 7. 您的種族或民族是什麼?請選擇所有適用項。

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* 8. 您溝通時的首選語言是什麼?

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* 9. 您是從哪裡聽說這個計畫的?請選擇所有適用項

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* 10. 我們與您聯絡的最佳方式是什麼?請注意:未經您的許可,我們不會共享您的聯絡資訊。我們將使用它來確認資格,讓您了解該計畫的最新進展或更改事項,或未來發送有關該計畫如何運作的問卷調查。

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