Neighbor Network of Northern Nevada Interest Form

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Please fill out this form to receive more information about N4 programs and to begin the application process!

First name: *

Last name: *

Email:

Phone number: *

Physical Address (house number and street): *

Address line 2 (apartment number, if applicable):

City *

State *

Zip Code *

Mailing Address (if different from physical)

Address line 2 (apartment number, if applicable):

City:

State:

Zip Code:

Gender:

Female

Male

Prefer not to say

Other:

Clear selection

Age *

18 - 29

30 - 49

50 - 65

65+

Prefer not to say

Other:

Please indicate which N4 programs you are interested in receiving more information about (check all that apply): *

N4 Transportation (Lyft and paratransit rides in Washoe County)

Volunteer Village (becoming a volunteer)

Time Exchange (neighborhood service exchange)

Community Care (in-home support services, including respite care)

General information about N4

N4 Connect (statewide transit system)

Required

Please indicate if you identify as a (check all that apply): *

Person who is 60 years or older

Person with a visual impairment

Person with a mental health disorder

Person with a physical disability

Person with Autism Spectrum Disorder

Person with dementia

Person with an intellectual or developmental disability

Person who provides care to a family member, friend, neighbor, etc.

Service provider

None of the above

Other:

Required

How did you hear about the Neighbor Network of Northern Nevada (N4)? *

Word of mouth

Internet search

Service provider

Social media

Community event

University or college

Through another N4 program

Other:

Required

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