Request for Assistance (Simpson Co. Literacy Center)
Please answer each question. You can ask to personally receive assistance, or you can give information for a person you want to receive assistance from this program.
Sign in to Google to save your progress. Learn more
1. Select your Language Preference *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report