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Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Phone
*
Preferred Contact Method
*
Email
Phone Call
Text Message
Language
*
Arabic
English
Mandarin
Spanish
Swahili
Other
If you selected "other", type the Family's Native language below
*
Will the Family Need an Interpreter?
*
select one
Yes
No
Unsure
Grade of Child/Children in Home Needing Support
*
Select all that apply
Pre-K
Elementary School
Middle School
High School
Who is completing this form?
*
The Cleveland Transformation Alliance defines family as trusted individuals who influence and support the well-being of another or self. Our goal is to be inclusive of all the different ways people form their families.
Family member
Ambassador
Self
Other
If you selected "other" in the previous question, please share additional information here.
*
Interested in receiving our newsletter?
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Select the topic area that interests you.
Family/Caregiver
Students
Is there any additional information you would like to share?