Request for General Assistance & Services or Appointment with WOT Task Team
This include Connection to WOT, Technical service or Assistance for resources.

*Note we ask for demographic for our GRANT reporting, not as a determining factor for participating. No personal information will be listed in grant reporting or publicly. All information provided is only for internal purpose and confidential. Thank you!
First Name *
Last Name *
Phone Number
Email *
Zip Code *
Age *
I Identify my ethnicity as: (select all that apply)
I am interested in participating or need assistance for: *
How can we help/support/assist you? *
Time options/ Availability to meet (for one on one appt) *checks all applicable please *
How did you hear about the this program?
Please share your reasons and interest to participate in any of this program activities or services?
Never submit passwords through Google Forms.
This form was created inside of Inclusive Inc-Women of Toledo. Report Abuse