Queens Complete Count Committee (QCCC) Application Form
Your first and last name: *
Your mailing address: *
A phone number where we can reach you: *
Your email address: *
Please list up to three organizations that you are active in. (Examples: Community Board, civic group, ethnic association, house of worship, nonprofit organization.) *
If you speak any languages other than English, please list them: *
Please tell us why you’re interested in 2020 Census outreach. *
Past experience: Have you done Census outreach before? *
If "Yes", briefly describe your experience: *
Public programs: Queens Complete Count Committee members are expected to attend virtual monthly public programs from 5:00 to 7:00 pm. Public program dates for July through September are TBD. *
If "No" or "Depends" please explain why:
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?) *
If you want to tell us anything else about yourself as a candidate for the Queens Complete Count Committee, please use the space below. *
Please Note:
The first phase of the Queens CCC runs from January to June 2019.
The second phase will run from September 2019 to October 2020.
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