YOUth First: Intake Form
Please complete the form below to connect with youth resources.
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First & Last Name *
Gender *
Email Address *
Phone Number *
Neighborhood *
Age *
Ethnicity *
Are you enrolled in school? *
School Name
Are you enrolled in a alternative program? *
Which type of resource(s) do you need support connecting with? *
Please share details about the specific support you need below.
How would you like to be contacted ? *
What's most important when connecting with a resource?
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How did you hear about this service?
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YOUth First serves to connect young adults with resources but can not grantee access to resources.  Please click below to acknowledge the terms of this service.
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