Phone: 954.561.9681
Fax: 954.561.9685
Email: PITvolunteers@brhpc.org
Broward Regional Health Planning Council
200 Oakwood Lane, Suite 100
Hollywood, FL 33020
2018 Point-In-Time Homeless Count
Thank you for your interest in participating in the 2018 Point-in-Time (PIT) Count. Please complete the following 6 steps to register as a volunteer.
Step 1: Volunteer Registration
*Please fill out all of the information below.
Either Mobile or Home phone is required.
(ie, 9541234567 or 19541234567)
Step 2: Confidentiality Agreement
*Due to the sensitive nature of some of the survey questions, we ask that you agree to the following terms.

Community Solutions Volunteer Confidentiality Agreement

As part of your work with Community Solutions, Inc. (CS) you may have access to view, update or modify sensitive information about CS and our partners clients and the CS operation. You must treat this information as confidential and not share with anyone unless specifically authorized.

CS defines Sensitive Information as:

  • Client names, nicknames or any other identifying information
  • Client address, location or whereabouts
  • Client personal finance information including social security numbers, financial data or related information
  • Client health information including information on medical conditions, treatment or history
  • Information on CS plans and operations

All information collected, access or viewed, as part of the CS survey is to be treated as confidential in written, electronic, printed and all other forms. Information is the property of CS and should not be released, shared or discussed without prior authorization. This includes communication in any form with clients, co-workers, outside agencies or any other party.

In the event of you are unsure if information can be shared, DO NOT DISCLOSE INFORMATION, contact your immediate supervisor or the CS Privacy Officer to obtain approval.

Unauthorized disclosure of CS information may result in disciplinary or legal action or may result in dismissal.

As a participant in the CS study I understand that I may have access to sensitive information as defined by CS. I agree to maintain the security and confidentiality of survey and related information as well as the security of CS IT systems. I will not disclose, share, publish, copy or distribute any survey or CS information without express permission. I will not disclose or share my username or password to CS systems and will report any questions, issues or suspicious activities to my supervisor or CS management.

RadDatePicker
RadDatePicker
Open the calendar popup.
Step 3: Photo Release

I hereby give my authorization to allow photo(s) and/or videos of myself to be included in Broward Regional Health Planning Council, Inc. publications. I understand that these publications will be widely distributed to the public as an enhancement to our health care system, and to further the educational aspects of that system.

I hold completely harmless the Broward Regional Health Planning Council, Inc. and all other parties that may use any such photos of myself in any of its publications for the above stated purposes. These publications are not intended to be used for the financial gain of any parties involved.

Step 4: Training / Orientation Selection
*Every volunteer is required to go through training/orientation unless you have participated in the Count within the past 2 years.
Step 5: PIT Shift Selection
*Please select one region to count from; multiple days and times can be selected for whichever region you choose.

Encampment/Street Count

Meal Site Count

Youth Matter Fair

Step 6: Teams
*If you prefer to Count with your own group please fill out the information below. (All team members MUST register individually to be included in the team; no more than 4 people per team)
Next   > (Click 'Next' to view confirmation page)