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Youth Impact Session Booking Form
Please complete this form to schedule a youth impact session with Antwann Mitchell Sr. We respond within 24 hours.
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Email
*
Your email
Full Name
*
Your answer
School/ Organization
Your answer
Role / Title
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Preferred Date for the Session
MM
/
DD
/
YYYY
Preferred Time
Time
:
AM
PM
Type of Session
School Assembly
Classroom Breakout
Alternative School Impact
Juvenile Program Session
Workshop
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Estimated Number of Students
Your answer
What challenges are your students facing?
Your answer
What outcome do you want from this session?
Your answer
How soon do you need confirmation?
Immediately
Option 2
Within 24 hours
Within 48 hours
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