Student and Family Advocate Program - Intake Form
Please fill out this form in order to contact our Student and Family Advocate. We will do our best to get back to you within 3 business days. This form is considered confidential. No information in this form will be shared with anyone outside of the Markham African Caribbean Canadian Association (MACCA) without your consent.
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Email *
First and Last Name *
Phone Number *
What is the best way to contact you? *
Required
What school board is/are your child(ren) a student in? *
Required
What grade(s) is/are your child(ren) in? Circle all that apply *
Required
Please specify issue *
Please describe your situation/issues below in as much detail as possible to our SFA *
If you have already raised your concerns with your child's school/board, please describe what actions (if any) have been taken to address your concerns so far *
On a scale of 1-5 how confident do you feel in being able to navigate the education system? *
I consent to MACCA acting on my behalf as my advocate at school/school board meetings. I understand that I can withdraw this consent verbally at any time. *
Required
I consent to the information outline in this submission being shared with MACCA's internal committees, who can provide advice and information to support me. I understand that I can withdraw this consent verbally at any time *
Required
I agree that by signing this form, MACCA can share this information with a trusted third party (e.g. a pro bono legal team) in order to support me in navigating the system. I understand that I can withdraw this consent verbally at any time. *
Required
I understand that MACCA will never share my personal information or story in a public setting without my expressed consent. I understand that I can withdraw this consent verbally at any time. *
Required
I consent to have this information, including personally identifying information, shared with MACCA's SFA *
Required
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