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IN CONTROL 4 PEACE
INTAKE FORM
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First and Last Name
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Your Email
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Your Phone
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Gender
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Race or Ethnicity
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Birthdate
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Address (including zip code)
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Are you currently employed?
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Are you currently in school or college?
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Are you currently
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What programs are you interested in?
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Podcast Production
Graphis Design
Seeking Employment
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What days and hours are you available to meet?
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What would you like to learn from IN CONTROL 4 PEACE in the next 12 weeks?
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What are your thoughts on violence in the City of Rochester?
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Have you been directly or indirectly impacted by violence in the City of Rochester, if so how?
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