Northside/Northline : Yes! to the Census Coordination Form
Thank you for coordinating with Houston in Action!

Together, we will ensure a complete count in Harris County and the City of Houston! Houston in Action plans to support organizations and leaders that live in the 10 regions with the lowest census response rates. With your support, Houston in Action will kick off this phase of the Census Campaign with Northside/Northline.

Please fill out this document to the best of your abilities based on new and/or planned activities and networks that you have relationships with in Northside/Northline.
Email address *
Your name *
Your answer
Name of your Organization/Business *
If you do not work with an organization and are signing in as an individual write N/A
Your answer
Phone Number *
Your answer
Check Yes or No based on the areas in Northside/Northline are you and/or your organization are going to focus in? *
Yes
No
Northside
Northline
Near Northside
Are there any other AREAS in Northside/Northline that you are prioritizing that are not on the list above? If yes please lest them below. *
If no write in "No."
Your answer
Pick your top three contact (lists) by clicking Yes or No based on the community leaders/influences you will reach out to. *
Check all that apply
Yes
No
Principals
Apartment Managers
Church/Mosque/Synagogue/Temple
Health Clinics
Restaurants / Food Trucks
Civic Clubs
Businesses
Community Centers/Parks
Are there any other Leaders/Influencers in Northside/Northline that you will be reaching out to that are not on the list above? If yes please list them below. *
If no write in "No."
Your answer
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