JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Count Me In: Pledge to Count 2020 Census
The Census counts. So do you. Pledge to be counted and to educate your community about the importance of the 2020 census.
* denotes required field.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
Your answer
Last Name
Your answer
Email
*
Your answer
Phone Number
Your answer
Address
*
Your answer
Zip Code
*
Your answer
I Pledge to Participate in the 2020 Census and I will:
*
Educate 3 members of my family about the 2020 Census.
Volunteer to phone bank or hustle (peer to peer text).
Download and share the PCEJ Digital Toolkit at
powercoalition.org
.
Other:
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Power Coalition for Equity and Justice.
Report Abuse
Forms