CCA Graduate Contact Information

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* 1. Address

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Birthday

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* 3. T-Shirt Size

2XL

Other (please specify)

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* 4. Favorite Scripture

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* 5. Family Information

Spouse Name

Anniversary Date

Child(ren) Name(s) and Age(s)

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* 6. Favorite food / Snack / Drink / Cake / Restaurant

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* 7. Goals for 2019-2020

Personal Goal

Professional Goal

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* 8. Prayer Requests for 2019-2020

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* 9. Is there a personal or professional goal you are trying to reach?

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* 10. Are there any barriers to reaching that goal?

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* 11. Is there any support that you currently need in one of these areas?

Employment

Health Issues

Housing

Food

Transportation

Driver's License

Legal Support

Counseling

Family Support

Parenting Classes

Work Certifications

Higher Education

Other (please specify)

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* 12. Would you like to volunteer at CCA? (No pressure! :) )

Tutor

Bring a Lunch

Serve on a committee that meets 3-4 times a year

Attend a committee meeting to represent CCA

Donate

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* 13. Are you interested in participating in a 12-week class, "Faith and Finance?"

Yes

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* 14. Are you working right now? If so, where?

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* 15. Are you in school right now? If so, where?

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* 16. What is your availability during the week to come to a Graduate Event?

9 am - 11 am

11 am - 3 pm

3 pm - 6 pm

6 pm - 9 pm