Person/Parent Intake Form
To better serve individuals and families, we have created this form.  Your personal information is completely confidential and will not be shared with any governmental or advertising agency without your consent.

Our unique program allows guests to request assistance on a number of community topics.  If you are seeking advocacy or would like to see improvements in advocacy in your area, please let us know.  Contact us at greatworksalliance@gmail.com.
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Email *
Name
What state are you in?  County? Country? *
Would you allow us to announce your request to our YouTube Channel and Team community?
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