Neighborhood Messenger Team
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First Name *
Last Name *
Email *
Mobile Telephone Number *
In what language(s) are you fluent? *
Required
What primary zip code do you currently live  in or lay your head at night? *
How long have you lived or laid your head in this zip code (# of years)?
Clear selection
If you have lived or laid your head in your primary zip code for less than 5 years, please list the Oakland zip code where you have lived or laid your head for 5 years or more?  Or write "Not Applicable"
How long have you lived or laid your head in this Oakland zip code (# of years)?
Clear selection
What zip code do you work, are self employed and/or operate a business/enterprise in?  If you are currently not working or operating a business or enterprise, put Not Applicable
How long have you worked, been self employed and/or operated a business/enterprise in this zip code (# of years)?
Clear selection
If you have worked, been self employed or operated a business/enterprise in your current zip code for less than 5 years, please list an Oakland zip code where you have worked, been self employed and/or operated a business/enterprise for 5 years or more?  Or write "Not Applicable"
How long have been self employed or operated a business/enterprise  in this Oakland zip code (# of years)?
Clear selection
If you have not lived, laid your head, worked, been self employed and/or operated a business/enterprise in Oakland for 5 years or more, please tell us which Oakland Zip code(s)  you are connected to and how, i.e your family/guardians lived, laid their head, were employed, operates or operated a business/enterprise there;  you hang out there -- a lot!, etc.?
If you no longer live, lay your head, are employed or operate a business/enterprise in Oakland, please select all that apply?
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This form was created inside of Black Cultural Zone Community Development Corporation/East Oakland Black Cultural Zone Collaborative.

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