Strong Foundations Intake Survey

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* 1. What is your name?

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* 2. What is your Y Number?

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* 3. What is your phone number?

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* 4. What is your email?

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* 5. What basic needs resources or information are you looking for?

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* 6. How would you like to be initially contacted?

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Email

Phone Call

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* 7. Is there anything else you would like to tell the Strong Foundations Coordinator?