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Census Kiosk Partner Location Application
Please provide the following information to apply to host a census kiosk. Find more information at [website] and reach out to [email address] with any questions.
Email *
Name of your organization
Type of organization
Clear selection
Name of your organization's main point of contact for this effort
Email address of main point of contact
Phone number of main point of contact
Name of facility/location where kiosk will be located
Address of facility/location where kiosk will be located
Owning entity
Does this location meet the requirements for supporting a census kiosk? [list requirements]
Clear selection
Hours of operation
Will this location have staff available to assist the public?
Clear selection
Hours of staff availability
Site phone number
Language support available at location (select all that apply)
Number of devices available
Computer type (desktop, laptop, tablet) and number of each
Can a phone land line be made available?
Clear selection
Does this location have a public facing counter?
Clear selection
Is this location ADA accessible? (see: https://www.ada.gov/2010ADAstandards_index.htm)
Clear selection
Building type
Clear selection
Describe parking and transportation availability for the public
Notes
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