Registration for California Tribal Families Coalition Listening Session 8/27 @ 10:00 AM

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Please use this form to register for attendance at a tribal community listening session on developmental disability services hosted by the California Tribal Families Coalition (CTFC). The event is located at Picayune Rancheria, 711 Lucky Lane, Coarsegold, CA 93614. We encourage participation in-person. You MUST register if you need childcare onsite.

CTFC has begun a new initiative that is focused on the health and wellness of our youngest tribal children population who have or are at-risk of having intellectual or developmental disabilities. We want to hear more about this topic from tribal community members in the Central Valley and surrounding areas - including tribal leaders and social service workers!

Tribal members and tribal employees may be eligible for a $100 Amazon gift card for participating in the entire listening session and submitting a completed a survey.

First Name *

Last Name *

Email *

Phone Number *

Are you a tribal member/citizen? *

Yes

Eligible or a descendent, but not enrolled

Other:

Tribal affiliation *

Do you work for a tribe? If yes, what is your role? *

Please share 2-3 sentences on why you are interested in attending this listening session. *

Please indicate here if you have any accessibility needs (i.e., an ASL interpreter) *

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