Sign Up for the Stanislaus County Point in Time Count 2022
Your basic info
First Name*
Last Name*
Email*
Phone*
Your profile
Are you registering as an indiviudal or as part of a group?*
Individual
Group
If you are registering as part of a group, what is your Team name? (Each team member must register separately.)
Do you have reliable transportation?*
Yes
No
If you have reliable transportation, do you have a vehicle you are willing to volunteer for the PIT Count?*
No
Yes - 4 seats
Yes - 6 seats
Yes - 8 seats
Have you previously participated in the count?*
Yes
No
Are you willing to be a team leader? Responsibilities might include choosing a meet-up location, confirming everyone on your team is set up with the mobile app, and at the end of the count confirming everyone on the team has submitted all surveys.*
Yes
No
Do you have a smart phone that you would be willing to use to help collect survey information during the count?*
Yes
No
Which mandatory virtual survey/homeless engagement training will you attend? (Must be able to join training via computer or smart device, cannot participate by call-in. You must be able to hear and view training slides being presented. A calendar invite with virtual meeting link will be emailed to you.)*
Tuesday, February 22nd from 9am-10:30am
Do you speak Spanish?*
Yes
No
COVID-19 Concerns
Are you in need of PPE (personal protective equipment) for yourself?*
Yes
No
Deployment Center
Preferred Location (City) for Volunteering*
Ceres (Ceres Community Center-Joey Chavez (209)404-7356 2701 4th Street Ceres, CA)
Denair
Empire
Hughson (Hughson Fire Protection District - Jose Vasquez (209)505-5345 2316 3rd Street Hughson, CA)
Keyes
Modesto (Courtyard Plaza- Jessica Hill (209)484-0670 1010 10th Street Modesto , CA)
Newman (Pioneer Park- Alicia Mendoza (209)862-4440 1250 Tulare Street Newman, CA)
Oakdale (Oakdale Rescue Mission- Brian Whitmeyer(209)481-7378 131 W. G Street Oakdale, CA)
Patterson (HOST House- Xavier Guluarte (209)345-4378 405 S. 4th Street Patterson, CA)
Riverbank (City Hall- Norma Manrique (209)495-7090 6707 3rd Street Riverbank, CA)
Salida
Turlock (United Samaritans Foundation- Maria Ramos (209)538-5751 220 S, Broadway Street Turlock, CA)
Waterford (City Hall- Patricia Krause (209)874-2328 101 E Street Waterford, CA)
If your first location (city) is unavailable, what is your second choice? (single choice)
Ceres
Denair
Empire
Hughson
Keyes
Modesto
Newman
Oakdale
Patterson
Riverbank
Salida
Turlock
Waterford
Emergency Contact
While we do not expect issues, we ask that volunteers identify an emergency contact.
Emergency Contact Name*
Emergency Contact Relationship*
Emergency Contact Phone Number*
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