Her World Initiative Intake Form
Answers to this form will only be accessible to the president of Her World Initiative, Ashton Justice, and the social work team. All answers will be kept confidential.
Sign in to Google to save your progress. Learn more
First Name
Last Name
Email Address
In which state do you currently reside?
Please briefly explain how you would like Her World to assist you?
Would you be willing to talk via Zoom or over the phone with someone from the social work team?
Clear selection
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Michigan. Report Abuse