Please correct the fields below:

The City of Shoreline wants all community members to have the opportunity to ask questions and give input on programs and activities that affect them.

To serve all people, the City of Shoreline follows Title VI of the 1964 Civil Rights Act and other federal and state laws which prohibit discrimination on the basis of race, color, national origin, sex, disability, or English language proficiency, and harm to the health of low-income and communities of color.

We ask that you VOLUNTARILY complete this survey to help us improve our future outreach efforts.

You are not required to fill out this form in order to participate. 

1
Project Name
 *
2
Meeting Date
3
Location of Public Meeting
4
Gender Identity
Gender Identity
5
Which of the following best describes your race/ethnicity?
 (Check all that apply)
Which of the following best describes your race/ethnicity? (Check all that apply)
6
What is the primary language(s) spoken in your home?
What is the primary language(s) spoken in your home?
7
Counting yourself, how many people live in your household?
Counting yourself, how many people live in your household?
8
What is your total annual household income?
What is your total annual household income?
9
How did you hear about this project/meeting/event?
 (Please check and/or list all that apply)
How did you hear about this project/meeting/event? (Please check and/or list all that apply)

Thank you!

Data will be used for City of Shoreline outreach efforts and collected by the Washington State Department of Transportation for Title VI compliance.

  1. To receive a copy of your submission, please fill out your email address below and submit.

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