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.
Montagnard Dega Association
611 Summit Ave Suite 10
Greensboro, NC 27405
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Country of Origin (where are you from)
A # (Green card or I-94 #) per our state funding requirement
Date of Birth
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?
Less than 1 year
Between 2-5 years
More than 5 years
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