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Skillcity Institute Client Intake Form
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Email
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Your email
Full Name (First name, Last name)
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Your answer
Gender
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Female
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Other:
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Age
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Your answer
Contact Address
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Your answer
Telephone (Mobile)
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Your answer
Occupation
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Student
College / University
Out of School
Employed
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Other:
What are your interests, talents and passions?
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Your answer
What kind of support do you need from Skillcity?
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Your answer
Do you have any mental health concerns?
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Yes
No
Maybe
How did you learn about Skillcity Institute?
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Website
Social Media
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Other:
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