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Join the AYA Support Network
We are forming a compassionate group of nonprofits, community members, faith groups, and businesses in Texas dedicated to providing direct support and crucial funds for adolescent and young adult cancer patients in need. Please tell us about the type of support you can offer.
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First and Last Name *
Email *
Phone Number *
Name of Organization/Group/Business (if applicable)
Website (if applicable) *
What is your role/job title? *
If we need to follow up with you, what's the best time of day to call? *
Required
Why do you want to be a part of the AYA Helping Hands Network? *
What territory/communities can you serve? i.e. National, all of Texas, just Bexar county, etc. *
Do you have any restrictions on the age, income, or other demographics of people you serve? *
Do you have an application process? If so, please provide the appropriate link and/or information. *
Do you offer resources in Spanish? *
What type of support can you offer for Basic Needs? Select all that apply
Please tell us more about your Basic Needs resources. Who is the best contact person for these resources if other than you?
What type of support can you offer for Financial Health?
Please tell us more about your Financial Health resources.  Who is the best contact person for these resources if other than you?
What type of support can you offer for Medical Care?
Tell us more about your  Medical Care resources.  Who is the best contact person for these resources if other than you?
What type of support can you offer for Emotional and Social needs?
Tell us more about your  Emotional and Social support resources.  Who is the best contact person for these resources if other than you?
What type of support can you offer for Daily Living needs?
Tell us more about your Daily Living resources.  Who is the best contact person for these resources if other than you?
What type of support can you offer for Other needs?
Tell us more about your other resources.  Who is the best contact person for these resources if other than you?
In what additional ways would you like to partner with the AYA foundation?
What else would you like us to know?
Do we have your permission to list your group on our website? *
If applicable, please email your logo to yumnakali@gmail.com

Thank you for joining the AYA Support Network!
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