Your last name:

Your first name:

 

Your CD is # ­­____ in Borough of _______

Your CD section subdivision, if any: ­­­­­­______

 

  • What are the issues, controversies, worries, hopes, etc., on the minds of folks with whom you spoke?:
  • Sources with whom you spoke:

1. Name:

Age:

Title or other description:

Telephone:

Email:

 

2. Name:

Age:

Title or other description:

Telephone:

Email:

 

 

 

3. Name:

Age:

Title or other description:

Telephone:

Email:

 

4. Name:

Age:

Title or other description:

Telephone:

Email:

 

5. Name:

Age:

Title or other description:

Telephone:

Email:

 

  • Your Community Board meets­­
  • Where?
  • When?
  • CB manager’s name?
  • His or her telephone:
  • Email: