Preliminary Questionnaire

Please fill out this questionnaire to the best of your ability. We WILL NOT use any of this information to exclude you from participating in our programs. You may be eligible for additional services or programs based on the criteria below.
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    If you answer YES to any of these questions you may be eligible for a program.

    This questionnaire is confidential and will be reviewed and evaluated only by a Soulciety Staff Member.
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