Provide some information about the Centre you are requesting support for, and the Primary Contact for the centre.

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* 1. Name

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* 3. Organization / Site Name

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* 4. Where is your organization located?

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* 5. Who is your All Kids Belong (AKB) Resource Consultant?

Request Details

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* 6. Please indicate why you are interested in this pilot project. What areas of support are you seeking?

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* 7. Which of the following areas of support are related to your request?

Acknowledgment

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* 8. Thank you for your interest and for taking the time to complete this survey. Due to capacity, only selected participants will be contacted for a follow-up discovery call. This call will focus on discussing alignment, expectations, and next steps prior to beginning in September/October 2025

Please check the box below to confirm that you understand and acknowledge this process:

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