Intake form: Employment and other Services 2021
Please complete this form, so that we can connect you with the correct staff member who will be assisting you.
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Montagnard Dega Association
611 Summit Ave Suite 10
Greensboro, NC 27405
336-373-1812
www.montagnardda.org
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Last Name *
First name *
Country of Origin (where are you from) *
A # (Green card or I-94 #) per our state funding requirement *
Date of Birth
Address *
Chose one: Do you have U S. Citizen, Green card or I-94? *
Phone number or email
Are you currently working with another agency? For example, Church World Services (CWS), African Service Coalition (ASC), World Relief, etc. *
If yes, which agency or referral agency?
What services do you need help with? Employment, resume, college application, social services, etc.
How long have you been in the U.S? *
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