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Loteria Festival San Augustino
Loteria Festival San Augustino
¡¡Gana una tarjeta de regalo de $25.00 para Red Lobster!!
Solo se necesita llenar el formulario abajo:
Join the Center! - Augustine
Form for Front Desk to refer clients who have called in for a service or a department specific questions
1. Name of Individual
(Required)
Nombre
Segundo Apellido
2. Phone
(Required)
3. ¿Tienes un correo electronica? // Do you have an email address?
(Required)
Si
No
Prefiero no responder
3a. Email
5. Métodos preferido de contacto / Preferred Methods of Contact
(Required)
Llamada
Mensajes de texto
Correo Electronica
6. Idioma Preferida / Preferred Language
(Required)
English
Spanish
Other
7. Program of interest / Programa de interes
(Required)
Asistencia financiera / Financial Assistance
Salud física / Physical Health
Salud mental / Mental Health
Empleo/ Work
Vivienda/ Housing
Recursos gobernantes / Government Funds
Necesidades básicas / Basic needs
Asunto legal (inmigración) / Legal Assistance (Immigration)
Asunto legal (no inmigración) / Legal Assistance (Not Immigration)
Educación de adultos / Adult Education
Programas de jóvenes . Youth Programs
Otro / Other : Favor de indicar abajo / Please identify in the field below
Númer de Boleto / TIcket Number
Como Supe del Centro? / How did you learn about the Center
Amigo / Friend
Familia / Family
Iglesia / Church
Página de Web / Internet
Facebook
Radio
Anuncio / Flyer
Escuela / School
Programa del Centro / SHC Program
Agencia de Servicio Social / Social Services Agency
Cliente de regressa / Returning Client
