Interest/Referral Form for Young Adult Programs at MN Valley Action Council
Thank you for your interest! A representative from MN Valley Action Council for your service area will contact you with more information upon completion of this form.
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What County do you live in? *
First and Last Name *
If you answer "YES" to any of the following items OR are interested in more information, please continue filling out this form and someone will reach out to you shortly regarding which programs you may be eligible for! (Income guidelines apply for some programs) Check all that apply *
Date of Birth *
Phone Number *
Email *
What is your mailing address? (Street/Po Box, City, State, Zip) *
What are the best ways to reach you? (Choose all that apply) *
Do you need an interpreter? If yes, what language *
What services are you interested in? *
Who is filling out/submitting this form? *
If you need assistance with this form, contact Sarah McDonald at 507-345-2439. If no assistance is needed, please 'submit' below and someone will be in contact with you soon!
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