#VaccinatePointBreeze Interest Form

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#VaccinatePointBreeze wants to knock on the door of all of the 65+ seniors living within Ward 36 and Ward 48. These neighbors have limited or no access to the internet and have been unable to sign-up. Each canvasser will knock on 30-40 doors per cycle and share information about accessing the COVID-19 vaccine. If you are interested in joining us, please fill out this form and someone will be in touch with you soon.

Trainings will be on 4/10, 4/17, and 4/24 (must attend, information may change from week to week).

If you have any questions, please email Emily Simpson at esimpson34@gmail.com

What is your name? *

What is your address? *

What is your phone number? *

What is your email address? *

Do you speak any of the following languages?

Spanish

Cantonese

Khmer

French

Madarin

Vietnamese

Other

Have you had experience canvassing before? *

Yes

If yes, what was the campaign?

Ways to volunteer: *

Confirm Volunteers/recruit volunteers

Canvasser

Pod leader (location for material pick-ups)

Co-Facilitate training

Turf cutter/data

Required

I can attend the following canvassing training sessions:

4/10

4/17

4/24

Submit

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