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Unidos Foundation: Service sign-up form
Este formulario es para apuntarse para recibir nuestros servicios
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* Indicates required question
Email
*
Your email
What is your Full Name? (Cuál es su Nombre Completo?)
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Your answer
What is you Phone Number? (Cuál es su número telefonico?)
Your answer
What is your full address? (Cual es su dirección completa?)
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Your answer
Which program are you looking to sign up for? (En cual de nuestros programas esta interesado en apuntarse?)
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SAFETY (FireSafe Kits | COVID Test or Vaccine), SEGURIDAD (Kits de prevencion de fuegos | Vacuna o Prueba de COVID)
EDUCATION (Mini Library, CyberLearning Club, Chromebooks), EDUCACION (La Bodaguita, Ayuda de Tarea Escolar, Computadoras)
SOCIAL INCLUSION (Nominate someone, sign up for a seminar), INCLUSIVIDAD SOCIAL (Nominar a alguien, Apuntarse para un seminar)
Other:
What area is most important to improve NOW in Lehigh Valley? (Cual area es necesaria de mejorar AHORA en el Valle Lehigh?)
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Affordable Housing / Homelessness (Albergue y ayuda de alquiler)
Employment (Empleo)
Youth Services and Recreation (Servicios para los ninos/la juventud)
Education (Educación)
Cultural/Community Center (Centro cultural y comunitario)
Other:
What is you average family income? (Cuál es el ingreso de su hogar)
$0 - $39,000
$40,000 - $79,000
$80,000 - $99,000
Over $100,000
Clear selection
What best describes your identity? (Cuál mejor describe su identidad étnica?)
White (Blanco)
Black (Negro)
Native / Indigenous (Indigena)
Hispanic / Latinx (Hispano / Latino)
Asian / Middle Eastern (Oriental)
Other:
Clear selection
What is your zip code? (Cuales es su codigo postal?)
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Your answer
What needs do you or your family have, which are not being addressed? (Cuales necesidades tiene usted o su familia, cual no estan siendo tratadas?)
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Your answer
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