Resource Intake Form

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Thank you for being a part of our mission to create safe and supportive communities of care for youth!

Please fill out this form with information on the resource you wish to include in our safety app.

Feel free to email alyissa.sagoes@digitalc.org and chenoa.miller@digitalc.org with any questions you have.

* Indicates required question

Email *

Record my email address with my response

Name of Organization *

Your answer

Organization Phone Number *

Your answer

Point of Contact (Name, Email) *

Your answer

Category of Resource *

Please enter the product number

Financial

Food

Housing

Mental Health

Academic

Safety

Other:

Required

What is the resource? *

Your answer

Website *

Your answer

Questions?

Your answer

Submit

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This form was created inside of Digital C. Report Abuse