WEDC Intake Form for Programs
Aloha! WEDC works to serve our Waianae Coast and broader communities. In order to do so, we need to know a little more about who we are serving. Please help our organization to gather this demographic information.
***Please know, all personal information gathered is CONFIDENTIAL and will not be made public or shared beyond WEDC.
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Email *
First Name
Last Name
If you are from the Waiʻanae Coast, what ahupuaʻa do you live in? (Ahupuaʻa is a valley or land division from the mountain to the sea)
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Zipcode
Please describe your ethnicity (Check all that apply)
Please select the correct age range
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Please choose the appropriate gender identity
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Are you a Veteran?
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How did you hear about us?
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What program are you involved in?
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What other WEDC services do you use?
Please share what topics you are interested in:
Media Release Information
You agree that the Company may use any written statements, images, audio recordings, video recordings or other forms of media by or of you, whether shared to or captured on publicly-operated or Company-operated platforms, related to your enrollment or participation in the Program. You waive any right to payment, royalties or any other consideration for the use of any written statements, images, audio recordings, video recordings or other forms of media. You waive the right to inspect or approve the finished product, including written or electronic copy. The Company is hereby held harmless and released and forever discharged from all claims, demands, and causes of action which you, your heirs, representatives, your estates have or may have by reason of this authorization.
I agree to the photo consent and release. Please type your full name and a /s/ before your name.
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