Youth Programs Workshop Request Form
Thank you for your interest in collaborating Youth Programs at Neighbors In Action (NIA).

Please fill out the form below to give us more information about your group and what you're hoping to gain from one of our workshops and introducing your group to our work. Provide us with as much information as possible.
Name of School or Organization *
Group Name or Class *
Address of School or Organization *
Mission or Group's Focus *
Name of Contact Person *
Phone number *
Email Address *
How did you hear about us?
Please check off your requested workshop: *
Please tell us more about the group you'd like us to work with including general demographics, ages, size, and any potential strengths or challenges. Why would you like to bring NIA Youth Programs to this group? *
What is your location? Please note if you would prefer coming to our office at 256 Kingston Ave in Brooklyn, NY. *
What are the hours and potential dates for the visit? *
Please check off any resources that your organization can provide: *
Never submit passwords through Google Forms.
This form was created inside of Demonstration Projects of CCI. Report Abuse