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🏛️ Civic Power & System Strategy Intake Form

Birthday
Month
Day
Year
Multi-line address
Are you employed?
Yes
No
Do you have a Valid ID or Driver's License?
Yes
No
Gender Identity
Preferred method of contact
Have you ever had legal involvement (arrest, charges, probation, etc.)?
Yes
No
What area(s) of the legal system do you need help understanding? (Check all that apply)
Have you ever voted in a local or national election?
Yes
No
Do you know who your city council rep or mayor is?
Yes
No
Not sure
What civic areas are you interested in learning more about? (Check all that apply)
Are you able to attend weekly workshops (in-person or virtual)?
Yes
No
Do you give consent to be contacted by C.R.I.P.S. about this program?
Yes
No
Yes, I consent to communication and updates about Civic Power & System Strategy and related programs
Yes
No
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