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A Helping Hand
Please fill out this form to let us know what services can benefit you and your family.
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Your Name
Your answer
Email
Your answer
Phone Number
Your answer
I need assistance with:
*
Emotional Support
Housing/Rent Assistance
Student School Attendance
Clothing/Shoes
Food
Hygiene Products
Academics
School Supplies
SNAP Benefits
Other:
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Student(s) Name
Your answer
If you answered other, please share what service(s) you need:
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Additional comments:
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Thank you!
I appreciate you taking the time to fill out this form so I can better assist you and your family. If you have any questions or concerns, don't hesitate to email me at lacuesta_f@4j.lane.edu or call me (541)790-6129.
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