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My Brother's & Sisters Keeper
Wayne County NY
Home
About
Services
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Intake form
Help us serve you better
Name
*
Email address
*
What is your age group?
Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 and above
What services are you interested in?
Please select at least one option.
Tutoring
Financial Education
Political Mobilization
Family Support Groups
Literacy Programs
Workforce Readiness
Cultural Awareness
Are you a parent or guardian?
Select
Yes
No
What is your current employment status?
Select
Employed
Unemployed
Student
Retired
Self-employed
What is your highest level of education completed?
Select
Some High School
High School Graduate
Some College
Associate Degree
Bachelor's Degree
Graduate Degree
How did you hear about my brother's and sisters keeper?
Select
Social Media
Word of Mouth
Community Event
Website
What challenges are you currently facing?
Which service or services are you interested in?
Please select at least one option.
African American: knowing who we are
Chess for success
Family support groups
<strong>Tie-a-Tie: </strong>
Additional questions or comments
Submit
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