Interest Form for the Young Adult Programs at Minnesota Valley Action Council
Thank you for your interest! An MVAC representative in your county will contact you with more information upon completion of this form.
First and Last Name *
If you answer "YES" to any of the following items OR are interested in more information, please continue filling out this form and someone will reach out to you shortly regarding which programs you may be eligible for! (Income guidelines may apply for some programs) Check all that apply *
Required
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
Email
What is your mailing address? (Street/Po Box, City, State, Zip)
What are the best ways to reach you? (Choose all that apply) *
Required
What services are you interested in? *
Required
What County do you live in? *
Do you need an interpreter? If yes, what language *
Required
Submit
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