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Kratos Elementa
+17204542462
josrphiswade100@gmail.com
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+17204542462
josrphiswade100@gmail.com
Intake form
Help us serve you better
Name
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Email address
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What services are you interested in?
Please select at least one option.
Counseling
Job Training
Financial Assistance
Health Services
Community Development
Youth Programs
What is your current employment status?
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Employed
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Student
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Please describe your current situation or need.
What is your age range?
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Under 18
18-24
25-34
35-44
45-54
55-64
65 and older
What is your preferred method of contact?
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Do you have any specific goals you would like to achieve through our programs?
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