COCEC
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Community Outreach for Educational Change (COEC)
Partner Sign Up Form
Full Name
*
E-Mail address
*
Phone number
*
Gender
*
Select Gender *
Male
Female
Prefer Not To Say
Name of group/Orgnization
*
Address
*
City of Residence
*
State Of Residence
*
In what capacity are you partnering with us?
*
Select item *
Individual
Non Profit
Community Group
Youth Group
Religious Group
Other
How would you like to partner with us?
*
Select item *
Fund A project
Work On a Project
Render a Service
What days are you available?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
How do you prefer we contact you?
*
Email
SMS
Phone call
Why do you want to partner with us?
*
Any Other Information
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