This form is intended to keep us in contact with members of the community and to follow-up with them
Have you had a negative encounter with the police?
More than 3 times
When was the last time it happened?
Less than 6 month ago
6 months - 1 year ago
More than 1 year ago
Do you want to do something about it?
What is the best way to contact you?
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This form was created inside of Providence Youth Student Movement.
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