Community Feedback Form for Temporary Migrant Shelter in the 22nd Ward

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form if you have any questions or feedback for the 22nd Ward Office regarding the Temporary Migrant Family Shelter at 2634 S. Pulaski Road, Chicago, Illinois 60623.

Complete este formulario si tiene alguna pregunta o comentario sobre el Refugio Temporal para Familias Migrantes en 2634 S. Pulaski Road, Chicago, Illinois 60623.

Nombre y apedillo

First name & last name

Are you a resident of the 22nd Ward?

Es residente del distrito 22?

Yes / Si

No / No

Clear selection

Cual es su direcion?

What is your address?

Cual es su correo electronico?

What is your email address?

Cual es su numero de telefono?

What is your phone number?

Please you share your questions and comment below. Por favor de compartir su pregunta o comentario aquí. *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms