Sign Up for the NorCal CoC 2021 Point in Time Count

Your basic info First Name* Last Name* Email* Phone Number*

Your profile Do you have reliable transportation?* If yes, do you have a vehicle you are willing to volunteer for the PIT Count? Are you participating in the count as an individual, or would you like to participate as part of a group?* If you are hoping to volunteer with family or friends, please choose a team name and have them use the same name when they register - this will help us to pair you up for the count! Have you previously participated in the count? Are you an outreach worker?* If you're not an outreach worker, are you comfortable talking to people whom are experiencing homelessness? Please describe your experience working with those experiencing homelessness.

Deployment Center All volunteers will be asked to meet at one of the following deployment centers:* If we don't have enough volunteers to cover different deployment sites, are you willing to change locations? If so, select all that apply:

Del Norte
Lassen
Modoc
Plumas
Shasta
Sierra
Siskiyou

* Unless notified you will be reporting to the deployment site of your first preference. Thank you for your flexibility.

PIT Volunteer Release Form

By signing below, I understand that I have agreed to serve as a volunteer for the Point-in-Time Count...

I have read, understood and will adhere to the local Confidentiality Policy:

Volunteer Signature*

Emergency Contact While we do not expect issues, we ask that volunteers identify an emergency contact. Emergency Contact Name* Emergency Contact Phone Number*

Additional Information If you have any additional information to add, please do so here: (500 characters or less)