Social Connections-Prospect Meeting Form
Please click on the link below to review our covid safety plans:
https://www.socialconnects.net/covid-response-act
Your Name *
I reviewed "Social Connections" Covid-19 safety practices and would like to: *
Please select (all) the areas of services you're interested in
(Optional) Please list your needs for support that you feel would help you maintain your goal(s) ex(advising, coaching, programming, training) etc...
Please set a deadline for your short/or long term goal(s) *
MM
/
DD
/
YYYY
Availability-Please list the time(s) you're most flexible daily/weekly?
Morning
Midday
Afternoon
Evening
Anytime
Unavailable
Monday
Tuesday
Wednesday
Thursday
Friday
Weekends Only
Any other comments or questions?
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