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Neighbor Network of Northern Nevada Interest Form
Please fill out this form to receive more information about N4 programs and to begin the application process!
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* Indicates required question
First name:
*
Your answer
Last name:
*
Your answer
Email
Your answer
Phone number:
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Your answer
Physical Address (house number and street):
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Your answer
Address line 2 (apartment number, if applicable):
Your answer
City
*
Your answer
State
*
Your answer
Zip code
*
Your answer
Mailing address (please enter "same" if mailing address does not differ from physical address):
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Your answer
Address line 2 (apartment number, if applicable):
Your answer
City:
Your answer
State:
Your answer
Zip code:
Your answer
Age
*
18 - 29
30 - 49
50 - 65
65+
Prefer not to say
Please indicate which N4 programs you are interested in receiving more information about (check all that apply):
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N4 Transportation (Lyft and paratransit rides in Washoe County)
Volunteer Village (becoming a volunteer)
Time Exchange (neighborhood service exchange)
Community Care (in-home support services, including respite care)
General information about N4
N4 Connect (statewide transit system)
Required
Please indicate if you identify as a (check all that apply):
*
Person who is 60 years or older
Person with a visual impairment
Person with a mental health disorder
Person with a physical disability
Person with Autism Spectrum Disorder
Person with dementia
Person with an intellectual or developmental disability
Person who provides care to a family member, friend, neighbor, etc.
Service provider
None of the above
Other:
Required
How did you hear about the Neighbor Network of Northern Nevada (N4)?
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Word of mouth
Internet search
Service provider
Social media
Community event
University or college
Through another N4 program
Other:
Required
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