Social Questionnaire
Name (First and Last) *
Your answer
Age *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
City of Residence *
Your answer
I would like a regular social activity to do every day.
I would like to meet other people who have similar interests.
I would like to find a place where I feel like I can belong.
I am nervous about meeting new people or going to new places.
I would prefer a Social Mentor over my family members to assist me with social needs.
What questions do you have about Social?
Your answer
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