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Ohana Center Intake Form
OHANA CENTER
“ Helping Families One Hand at a Time”
Ohana Center’s mission is to provide families with the tools they need to stay on the road to stability.
Our vision is to bridge the gap between the community and home life.
We aim to support underserved and unsheltered individuals and families working towards a brighter future.
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First & Last Name
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Your answer
Email
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Your answer
Phone Number
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Your answer
Best way to contact you?
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Your answer
Zip Code
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Your answer
Which Ohana Center program(s) are you interested in participating in?
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EARTH Program (Empowerment, Art, Resiliency, Teaching, and Healing)
SHARA Program (Sister Healing and Rising through Adversity)
TEACH (Trust, Equity, Access, Community, Healing)
Operation Hydration
BMACA (Black Maternal Alternative Care Alliance)
Birther's Wellness Circle
Other:
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Do you need linkage to a specific resource?
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Yes
No
Tell us how we can assist you, in getting to connected to the right resource?
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Your answer
How did you hear about Ohana Center?
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Your answer
Are you on social media? Follow us on IG @ ohana.centerav and OhanaAV on Facebook
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Yes
No
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