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Mobile Testing Set-up Form
Please fill out this form if you would like to participate in the mobile testing program.
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* Indicates required question
Email
*
Your email
Agency Name
*
Your answer
Project Name
Your answer
Agency Primary Point of Contact POC) Name
*
Your answer
Agency Primary Point of Contact POC) email address
*
Your answer
Agency Primary Point of Contact POC) email phone number
*
Your answer
Project Street Address ( number, street, city/town, zip code
*
Your answer
Participants: Please provide average number of clients on-site (be sure to indicate how many adults and children)
Your answer
Special instructions for access ( where to park, where to find main door)
*
Your answer
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This form was created inside of Rhode Island Coalition to End Homelessness.
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