Peer and Community Care Networks
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Name *
Organization or group (if applicable):
Email *
Phone Number
What is the best way to reach you?  *
I am interested in: (Check all that apply) *
Required
Do you have any special skills or interests you'd like to tell us about?
What language(s) do you speak?
Role
Pronouns *
Required
Are you a parent who has been impacted by ACS / the family policing system? *
Have you been part of Rise in the past?
If in NYC, select your borough/location: *
If outside of NYC, where do you live? (city and state)
What times are typically best for you to participate in this course? (Select all that apply) *
11am-2pm
12-3pm
1-4pm
2-5pm
3-6pm
4-7pm
5-8pm
Not free this day
Tuesday
Wednesday
Thursday
Friday
Saturday
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Thank you! We look forward to connecting with you.
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