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Neighborhood Liaisons Registration

2. First Name *
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Telephone Number*
14. E-mail Adresss*
18. Does your neighborhood have an organization or association? (please check one)*

    1. Yes, a neighborhood association
    2. Yes, a homeowners association

    1. Yes, a renters association
    2. Not that I'm aware of
20. Name of Neighborhood Association, HOA or Renters Association
22. Association Website or Facebook URL (if applicable)
24. Are you involved in any community groups?*

    1. Yes
    2. No
25. If YES, please name them.
27. Meeting Preferences: Indicate the days and times that would make it easiest for you to meet virtually or have a physically distanced conversation. You may select more than one option.

    1. Monday afternoon
    2. Monday evening
    3. Tuesday afternoon
    4. Tuesday evening
    5. Wednesday afternoon

    1. Wednesday evening
    2. Thursday afternoon
    3. Thursday evening
    4. Saturday afternoon
    5. Saturday evening
29. I plan to share information with my neighbors through

    1. Email
    2. Text
    3. Facebook

    1. Nextdoor
    2. Flyers
    3. Other
31. Other ways I plan to share:
35. Demographic Information
    The demographic information below is voluntary but requested because we want to be intentional about representation from all points of diversity, and especially from racial and ethnic groups that are underrepresented in our volunteer groups.
37. About how long have your lived in Carrboro?

    1. Less than 6 months
    2. 6 months - 5 years
    3. 6-10 years
    4. 11-20 years
    5. 20+ years
38. What is your age?

    1. 18-34
    2. 35-44
    3. 45-54
    4. 55-64
    5. 65-74
    6. 75+
40. Gender Identity
42. Which of the following best describes your race/ethnicity?

    1. Asian/Pacific Islander
    2. White
    3. American Indian/Eskimo
    4. Black/African American
    5. Hispanic/Latino
    6. Other
43. What is the primary language spoken in your household?

    1. English
    2. Spanish
    3. Burmese
    4. Karen
    5. Chinese
    6. Other
45. Other race/ethnicity:
46. Other language:
48. How many children under the age of 18 live in your household?
50. Are you a student?*

    1. Yes
    2. No
51. If YES, where are you currently enrolled?
55. Thank you for your participation!
56. SignUP Carrboro!
    Offering email and text updates
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field