What zip code are you in? (spend most of your time)
Your answer
Where do you sleep/rest at night? (or day)
Your answer
Do you have sheltering where you stay or where you rest? (tent, car, tarps, store front, trees)
Clear selection
Do you have a disability? *optional to disclose
Clear selection
Do you have access to a phone?
Clear selection
Do you have income?
Your answer
Have you ever had a fine or fee from the City and County of Sacramento that was difficult to pay or afford?
Clear selection
Please indicate what fines and fees from the City and/or County of Sacramento that have most affected you. Please be as specific as possible. (Ex. Towing or Probation fees)
Your answer
Were any resources made available to assist you in paying the fine or fee, such as financial assistance?
Clear selection
What could help you with your fees and fines situation that you are or did experience? Check all that apply
Is there anything else you would like to share about the City and County fines and fees?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of clapsac.com. Report Abuse