PIT Count Volunteer Registration

Introduction

This form is to register as a volunteer for the 2022 Youth PIT Count. The count is a vital component for ensuring the well-being of young people experiencing housing instability in Durham and better understanding the housing and service needs of youth experiencing housing instability. Teams conducting this count will be 2-3 young adults, ages 17-25, accompanied by another adult. Some teams may be accompanied by law enforcement. Teams will be assigned to a specific area of the community, e.g. the Southpoint Mall. Volunteers will approach people who appear to be under age 26 and ask them to complete a brief, online survey about themselves and their housing. Volunteers administer surveys and distribute donated items to homeless persons to thank them for their participation. For more information please email: durhamopeningdoors@durhamnc.gov

First Name*

Last Name*

Phone Number*

Email Address*

I will be able to use my personal cell phone or mobile device during the count*

I am willing to download the "Counting Us" mobile app to my cell phone or mobile device.*

Preferred Pronouns*

Gender

Age*

If you are age 26 or older, you are consenting to be a team lead by submitting a volunteer application. If you are not willing to be a team lead and are in this age group, please do not submit this application. For questions about team lead responsibilites please email durhamopeningdoors@durhamnc.gov

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Parent/Legal Guardian Information

Name of Parent/Legal Guardian*

Email Address of Parent/Legal Guardian*

Phone Number of Parent/Legal Guardian*

Covid 19 Vaccination Status*

You must be vaccinated to serve as a volunteer.

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How will you get around during the count?*

All volunteers will be resonsible for meeting their team lead at their assigned count location. Additionally, team leads will need to pick up survey materials at 516 Rigsbee Ave prior to their shift.

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Please select all shifts for which you are available

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How many shifts would you like to volunteer for?*

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Volunteer Training*

You will need to sign up for one of the two training times listed below.

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Are there specific people you would like to be on a team with, if possible?*

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Please list the names of the person/people you would like to be on a team with.*

List up to four people

Location Preference

Depending on the number of volunteers, we may not be able to assign you to your preferred location.

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Emergency Contact Information

Emergency Contact Name*

Emergency Contact Phone Number*

Relationship to Volunteer*

I confirm that I have signed the participation agreement*

All volunteers are required to sign the participation agreement, which can be found using this link: https://app.smartsheet.com/b/form/542cfa55b92b4f66a0c2414556681228

I confirm that I have signed the confidentiality form.

All volunteers are required to sign the confidentiality form, which can be found using this link: https://app.smartsheet.com/b/form/9f18e659e0d94535a5ee0eaf5aa4d88c

By submitting this form, I testify to the truthfulness and accuracy of all of the information provided.*

Send me a copy of my responses

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