Signs

Form

Required fields are marked with asterisks (*)

Neighbourhood Block Connector

Name (First and Last)

Phone Number:

Email:

Address

Why do you want to become a Neighbourhood Block Connector?

Neighbourhood Block Connectors interact and bring together people of diverse backgrounds, beliefs, and personal experiences. Can you commit to treating everyone in your range with full inclusion and without bias?

Yes

How much time do you feel you could commit to connect with your neighbours on a monthly basis?

Neighbourhood Connectors will be asked to attend a training session prior to starting the program. What times are you available for training? Select all that apply.

Weekdays - Mornings

Weekdays - Afternoons

Weekdays - Evenings

Weekends - Mornings

Weekends - Afternoons

Weekends - Evenings

Where did you hear about the Neighbourhood Block Connector Program?

Additional Comments