JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2020 Census Ambassador Volunteer Application
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Middle Name
Your answer
Last Name
*
Your answer
We All Count!
Gender
Female
Male
Prefer not to say
Other:
Clear selection
Age Range
Under 18
18 and over
Clear selection
Address
Your answer
Address (continued)
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Primary Phone Number
Your answer
Indicate work/home/cell
Work
Home
Cell
Clear selection
Secondary Phone Number
Your answer
Indicate work/home/cell
Work
Home
Cell
Clear selection
Preferred method of contact in urgent situations
Phone
Email
Clear selection
Emergency Contact
Your answer
Primary Phone Number
Your answer
What is your first/primary language?
Your answer
What languages can you speak fluently?
Your answer
Availability?
Weekday daytime
Weekday evenings
Weekends
Clear selection
Location Preferences
Silver Spring
UpCounty (Gaithersburg, Germantown, Clarksburge, Poolsvile, etc.)
MidCounty (Aspen Hill, Glenmont, Kemp MIll, Kensington, Olney)
Bethesda-Chevy Chase (Rockville, Potomac, Bethesda, Chevy Chase)
East County (Briggs Chaney, Burtonsville, Colesville, Fairland, White Oak)
Clear selection
I consent to the County’s use of any photographs taken or videos made in promotion of the 2020 Census.
Agree
Disagree
Clear selection
Even Santa Knows Everyone Counts in Montgomery County!
I understand that if I require an accommodation to perform my volunteer assignment, I need to discuss any medical or other needs with the person in charge prior to beginning the assignment.
Agree
Disagree
Clear selection
I acknowledge that submission of this form validates that the above information is correct.
Agree
Disagree
Clear selection
Are you signing up as a member of a group or organization?
Yes
No
Clear selection
If yes, what is the name of your group or organization?
Your answer
If "yes", what kind of group or association is it?
Non-profit
Faith/faith-based Community
Civic Association
Corporate
Homeowners Association
Montgomer County Govt. Agency
Clear selection
Are you willing to serve as Team Captain for your group?
Yes
No
Maybe
Clear selection
Have you signed-up for a training?
Yes
No
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
