Request edit access
2019 Second Chance Alliance Lobby Day Sign- Up
Please use the following form to let us know that you'll be joining the 2nd Chance Alliance for its 2019 Lobby Day activities in Raleigh, NC on May 7th, 2019.
Emergency Contact Name
Emergency Contact Phone Number
A majority of Lobby Day programming will use spoken English as its primary form of communication, but we strive to make our activities as inclusive and accessible as possible. Though we cannot provide translations for all languages, we do want to be aware of language needs so that we can accommodate as much as possible this year and make strides in the future to continue to remove this barrier.
A majority of Lobby Day programming will use spoken English as the primary form of communication. Is there a language translation that you need in order to participate in our activities? If so, what language supports do you need?
Do you have any accessibility needs that the coalition should plan for?
If you answered "Yes" to the question above, please take a moment to let us know how to best accommodate you.
From which geographic area would you be coming?
Not Applicable/I will not be using this transportation option
4XL or Larger
I Prefer Not to Respond
This information is used SOLELY to collect data to tell us what communities are represented at this event.
Prefer not to say
Option Is Not Listed Here
31 - 49
Are you directly-impacted by the Criminal Justice system? (Are you currently incarcerated, formerly incarcerated, or on probation?)
Prefer Not to Answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service