INTAKE FORM - FOR EVERY GIRL
Creating a world where Every Girl is free from Gender Based Violence
Name *
Your answer
Date of Birth *
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DD
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YYYY
Age *
Your answer
Cell Phone Number *
Your answer
Can we text you? *
Where do you live? *
Your answer
School (or last attended school) *
Your answer
Last completed grade *
Your answer
What social media do you use (Check all that apply) *
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Do your parents have access to your phone ? *
Do they have any issues with your use of phone, text, or electronic communication? *
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