Jefferson Counts Census Champions Sign Up Form
Each decade, the Census allows communities the opportunity to impact federal, state and local governments through a complete and accurate count of the population. The Jefferson Regional Foundation and Jefferson Community Collaborative have launched a Census Leadership Team to guide the development of a local plan to support strong Census participation in the Jefferson Area.

We are currently recruiting Census Champions! These local organizations will help promote Census participation by educating community members and sharing Census resources over the next year. If your organization would like to become a Census Champion, please complete the form below and stay tuned for more details!

Please include the information below for your organization's designated Census contact.
First & Last Name *
Your answer
Title *
Your answer
Organization Name *
Your answer
Phone Number *
Your answer
Full Address (Address, City, State, Zip) *
Your answer
Email Address *
Your answer
Select your organization's level(s) of engagement. *
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Please check any communities or populations below that your organization will strongly impact through your Census outreach. Check as many as apply. *
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Please specify primary geographies your outreach will impact within our South Hills and Mon Valley area. Please list the community(ies) and zip code(s) below. *
Your answer
How did you hear about Jefferson Counts Census Champions? *
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