CCA application
Cultural Compassion Alliance Application Form
Email *
 What is your full legal name? *
What is your prefered email?
what language(s) do you speak?
What country/countries you immigrate from? *
Do you live in either Middlesex County or Worcester county? (If you live in neither, press neither) *
Are you Married?
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how many children do you currently take care of? *
When did you move to the United States? *
What non legal/financial assistance might you require?
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Is there any other non legal/financial assistance you may need?
Would you potentially need legal assistance in case of deportation and/or other disputes relating to citizenship? *
have you worked while in the United States? *
If you have worked in the united states, have you ever been fired? *
Have you ever been convicted of a crime, pleaded guilty, or pleaded no contest in the United States? In other words, while in the United States, have you ever been in legal trouble?
 *
Do you have relatives in Massachusetts? *
Which town/city in Massachusetts do you live in? *
Do you have any questions and/or concerns?
A copy of your responses will be emailed to .
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