Census Assistance Hub Registration
Please provide the following information to apply and be considered as a host site for a Census Assistance Hub.  Find out more information at (website) or email Linda Steinberg, Special Projects Coordinator at CUPHD at lsteinberg@c-uphd.org.
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Email *
Name of Organization or Business *
Organization or Business Address *
Contact Person's Name *
Contact Person's Email Address *
Contact Person's Phone Number *
Type of Organization or Business *
Location of Proposed Census Hub (ex: lobby, back room, office, etc) *
Does this location meet the requirements for supporting a Census Assistance Hub? (see: https://nextcenturycities.org/census-kiosk-toolkit/#deployment) *
Hours of Operation for the Organization or Business *
Time
:
Proposed Hours of Census Assistance Hub *
Time
:
Does your site have bilingual support capability? *
If your hub site is bilingual, what languages can you support?
Do you have a computer, tablet or laptop that can be used during the Census Hub hours? *
Do you have WIFI or internet capabilities to support the Census Hub? *
Does this location have a phone line that can be used during Census Hub hours? *
Is this location ADA accessible? (see: https://www.ada.gov/) *
Building Type *
Describe parking and transportation availability for the public to access the Census Hub at your location. *
Any additional notes:
A copy of your responses will be emailed to the address you provided.
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