Targeted Community Action Plan Committee Sign Up Form
The purpose of this form is to determine the Targeted Community Objectives that members want to work on, if they want to be a Action Plan Committee lead, and when members are available to meet, so we can organize our community in order to work together to take positive action to end targeting.


Email address *
Contact Information
Name *
Your answer
Facebook Profile URL Or Name
Your answer
List the TI groups and organizations that you are part of and your role/position in them.
Your answer
Objectives Interest List
Here is a high level list of our objectives. Select any that you would like focus your coordination efforts on.
Objectives *
Required
Strategies Interest List
Please choose the strategies that you are or would like to become involved in.
Community Development *
Required
Support *
Required
Coping and Shielding *
Required
Research and Prove *
Required
Public Engagement Strategies *
Required
Legal Action *
Required
Policy Change *
Required
Meeting Availability And Agenda
When are you available for meetings? Select all that apply.
9 AM -12 PM EDT
12 PM - 3 PM EDT
3 PM -6 PM EDT
6 PM -9 PM EDT
9 PM - 12 AM EDT
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Are you interested in a leadership position?
Is there anything else that you would like to add?
Your answer
A copy of your responses will be emailed to the address you provided.
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