Queens Complete Count Committee (QCCC) Application Form
Your first and last name: *
Your answer
Your mailing address: *
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A phone number where we can reach you: *
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Your email address: *
Your answer
Please list up to three organizations that you are active in. (Examples: Community Board, civic group, ethnic association, house of worship, nonprofit organization.) *
Your answer
If you speak any languages other than English, please list them: *
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Please tell us why you’re interested in 2020 Census outreach. *
Your answer
Past experience: Have you done Census outreach before? *
If "Yes", briefly describe your experience: *
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Public programs: Queens Complete Count Committee members are expected to attend monthly public programs from 6:00 to 8:00 pm at Queens Borough Hall. Public program dates are: Thursday, January 23rd - Thursday, February 13th - Wednesday, March 4th - Tuesday, April 7th - Wednesday, May 6th - Thursday, June 11th *
If "No" or "Depends" please explain why:
Your answer
Reporting back: Queens Complete Count Committee members are expected to report the information from these public programs back to a specific community group. Which community group will you report this information back to, and how will you share it? (Examples: Will you have a speaking role at your group's meetings? Will you prepare summaries for your group's newsletter?) *
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If you want to tell us anything else about yourself as a candidate for the Queens Complete Count Committee, please use the space below. *
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Please Note:
The first phase of the Queens CCC runs from January to June 2019.
The second phase will run from September 2019 to June 2020.
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