2013 Santa Clara County Point-in-Time Homeless Count Volunteer Registration

The 2013 Homeless Census will be conducted in Santa Clara County on the mornings of January 29th and 30th. Volunteers will be paired with an expert homeless guide and asked to walk or drive designated routes, as a team, to do a visual count of individuals residing on the streets. The area surrounding the cities of San Jose, Los Gatos, Gilroy and Morgan Hill will be counted, or enumerated, on January 29th from approximately 6:00 am to 11am. The areas surrounding the cities of Palo Alto, Mountain View, Los Altos, Sunnyvale, Santa Clara, Saratoga, and Campbell will be enumerated on January 30th, 2013. We ask that all volunteers attend one of the trainings offered prior to the count.

Once you have completed this survey you will receive a confirmation email. More information regarding the trainings and count will be emailed to you as the date approaches.

Thank you for your interest in volunteering for the 2013 homeless census.

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1. Your Information:

First Name:

Last Name:

Agency/Organization:

Email Address:

Phone Number:

Cell Phone Number:

Mailing Address:

City:

Zip Code:

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2. On which day(s) would you like to participate in the homeless street count? (Mark all that apply)

a. Tuesday, January 29th, 2013 (South San Jose, Gilroy, Morgan Hill)

b. Wednesday, January 30th, 2013 (North San Jose, Santa Clara, Cupertino, Palo Alto)

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Will you be bringing other volunteers with you?

Yes

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What are the name of those you are bringing with you? (so we can build your team)

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Do you have a car you will be willing to use for the count? (we will need one car per team)

Yes

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3. What geographic area are you most comfortable with or knowledgeable about?

Gilroy

Morgan Hill

South San Jose

North San Jose

Mountain View

Alum Rock

Los Gatos

Willow Glen

Cupertino

Saratoga

Palo Alto

Los Gatos

Other (please specify)

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4. In what language are you conversationally fluent? (Check all that apply)

English

Spanish

Other (please specify):

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1. Your Information:

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2. On which day(s) would you like to participate in the homeless street count? (Mark all that apply)

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Will you be bringing other volunteers with you?

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What are the name of those you are bringing with you? (so we can build your team)

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Do you have a car you will be willing to use for the count? (we will need one car per team)

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3. What geographic area are you most comfortable with or knowledgeable about?

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4. In what language are you conversationally fluent? (Check all that apply)

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5. If you have any additional information to add, please do so here: