Programming Registration
All information shared is sent confidentially to Endaayaan Awejaa and is protected by law. We appreciate you taking the time to register with Endaayaan Awejaa.  Miigwech!
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Email *
First & Last Name *
Date of Birth
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Gender & Pronouns
Address *
Phone number *
How would you like to be contacted? *
Background *
Required
Types of Support Services *
Required
What is your current employment status?
What is your current education level?
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Current Source of Income
Current Living Situation
To what extent would you rank your current knowledge and exposure to your culture?
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How are you currently feeling emotionally? 
How are you currently feeling mentally?
How are you currently feeling spiritually ?
How are you currently feeling physically?
Is there anything you'd like to work on in order to approve yourself mentally, emotionally, spiritually, or physically ?
What would be the biggest help to you in this moment of your life if you had to say. 
Please do not downplay your situation we need to know your genuine response so that we can best support you at this time. It is also important to remind you there is never any judgement and everyone deserves to be understood. 
Do you have any dependents ?
If any dependents, please list names and date of birth.
Emergency Contact - First & Last Name, Relation, Contact Number
I understand that when accessing the services of the Endaayaan Awejaa that I must conduct myself in a safe & respectful manner to everyone involved in the program. *
Required
I understand that all the information I have provided legally binding or otherwise is true and authentic to the best of my knowledge and belief. I declare verbal consent that I am solely responsible for providing this information in court of law. 
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Today's Date *
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