Thank you for your interest in the Civic Assembly on Youth Homelessness

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In July, 12,750 households in Deschutes County were randomly selected to be invited to take part in the Civic Assembly for Youth Homelessness. If you received a letter, there is still time to apply to be part of a lottery to become a Delegate to the Assembly. Delegates will address the question:

"What should our priorities be for building community solutions to prevent and end youth homelessness?"

If you are selected to serve on the Assembly, you will receive a $450 stipend for your time. Fill out this form to apply or to learn more about the Assembly.

PLEASE COMPLETE A SEPARATE FORM FOR EACH MEMBER OF YOUR HOUSEHOLD AGED 16 & UP.

Para completar este formulario en español, haga clic en este enlace.

YES, I am interested in the Civic Assembly on Youth Homelessness. I received an invitation in the mail, and I would like to apply to be a Delegate to the Assembly.

Yes, and I have my invitation letter.

Yes, but I no longer have the invitation letter.

I don't remember. Please have someone contact me about whether I was sent an invitation.

I did not receive an invitation, but I would like more information about the project.

Clear selection

Invitation Code - If you have your invitation letter, please enter the 5 digit code found in the upper right hand corner of your response form.

First Name
*

Last Name *

Street Address
*

City or Town *

Zip Code *

Phone Number
*

Email
*

Primary Language
*

Age Group
*

16-24

25-34

35-44

45-54

55-64

65-74

75+

Highest Education Level Attained
*

Some schooling but no diploma

High school diploma or equivalent

Some college or Associate’s degree

Bachelor’s degree or higher

My household...

Note: If the property at the address above is not a residence (e.g., it is a business) OR if this property is a vacation or second home OR if you otherwise do not live at this address as your primary residence, you are not eligible for this particular lottery – even if your primary residence is elsewhere in Deschutes County.

Owns this address as our primary residence

Rents this address as our primary residence

Is currently unhoused

Which best describes how you most identify? *

Female

Male

Another gender identity

Which best describes how you most identify?

Note: These categories are matched to Census data. Although Middle Eastern & North African will become a future US Census category, the current Census encouraged MENA respondents to mark "White."

Asian or Pacific Islander

Black or African American

Hispanic or Latina/e/o/x (of any race)

Native American or Alaska Native

White*

Multiracial

Which party are you registered with? *

Democratic Party

Republican Party

Another party, Unaffiliated, or Not registered

I certify that all of the following are true:
*

I received this invitation mailer at my primary residence or through a social service agency, not at a business address, second home, or other address.

I am not a current elected official.

I am able to commit to participate in the Assembly on all of the following dates, from 9 AM to 4:30 PM each day: Sat.–Sun., Sept. 14-15, and Fri.–Sun., Oct. 4-6

I understand that missing more than 8 hours of the Assembly will disqualify me from continuing as an Assembly Member.

Required

I certify the information on this form is true to the best of my knowledge. *

I certify the information on this form is true to the best of my knowledge.

Required

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