Client Interaction Form
Due to Covid-19, this form must be filled out each time a Cooperative Extension staff member comes in contact with a client. The client can fill out this form on their phone OR the staff member can use their own device to fill out the form for the client.
Extension staff member you had primary contact with: *
First & Last Name *
Phone Number *
Email Address
Gender
Clear selection
Hispanic or Latino
Clear selection
Race
Clear selection
Thank you!
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