General Assessment

General Assessment
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This is to help us measure how many persons within a family unit that we could potentially assist. Please include them even if they do not live in your immediate household.
Please select no more than three (3) options.
Please select no more than two (2) options.
Note: This question is asking you about participating in one particular session or topic.
Please select no more than two (2) options that are your priority.
Available any time8a to 1p1:30p to 5:30p6p to 9pUnavailable
Monday
Available any time
8a to 1p
1:30p to 5:30p
6p to 9p
Unavailable
Tuesday
Available any time
8a to 1p
1:30p to 5:30p
6p to 9p
Unavailable
Wednesday
Available any time
8a to 1p
1:30p to 5:30p
6p to 9p
Unavailable
Thursday
Available any time
8a to 1p
1:30p to 5:30p
6p to 9p
Unavailable
Friday
Available any time
8a to 1p
1:30p to 5:30p
6p to 9p
Unavailable
Please select availability for each day.
Available any time8a to 1p1:30p to 5:30p6p to 9pUnavailable
Saturday
Available any time
8a to 1p
1:30p to 5:30p
6p to 9p
Unavailable
Sunday
Available any time
8a to 1p
1:30p to 5:30p
6p to 9p
Unavailable
Please select availability for each day.