PORTS - ROC the Block Survey

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* 1. Neighborhood

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* 2. Address of the concern

Address

Address 2

City

State

ZIP

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* 3. Concern

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* 4. What action would you like to see taken to address your concern?

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* 5. How do you define success or what would you like to see accomplished with ROC the Block?

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* 6. Do you wish to be contacted by the department handling the concern?

Yes

No