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Affirming YOUth Wants to Learn About YOU
The Affirming YOUth Foundation is excited to deepen our understanding of both our prospective and current participants. To better cater to your needs, we kindly ask that you take a moment to complete the information in the sections provided below.
Once you've filled out the form, a member of the Affirming YOUth Foundation team will be in touch with you within 24 to 48 hours. We look forward to connecting with you!
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* Indicates required question
Please specify the intended recipient of the referral:
*
Yourself {Participant}
As a parent or guardian, I would like to refer my child or dependent.
Other (e.g., JSD, JDD, Community Resources, etc.)
If you're not the participant, please specify your relationship to them:
*
Parent/ Guardian
Other
Not Applicable (N/A) - Please select this option if you are the interested participant.
Please provide your first name:
*
Your answer
Please provide your last name:
*
Your answer
Please provide your date of birth:
*
MM
/
DD
/
YYYY
Please provide your email address:
*
Your answer
Please provide your phone number:
*
Your answer
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