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Stand In The Gap Information
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Email
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Your email
Name
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Address
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Best phone for text/calls
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Please check all boxes
I verify that I have lost income directly related to work changes due to Coronavirus.
You may contact me to discuss my situation.
Check all that apply. I am a/n:
Current 4C Member
Active 4C Volunteer
Active 4C Attender in the last 4 months
My family member who is either a current 4C member, active 4C Volunteer, and Active 4C Attender.
Your answer
Best Phone Number for Family Member
Your answer
Where did/do you work?
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When did you/will you lose income?
Your answer
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