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Hmong Children Empowerment Inc.
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Intake form
Help us serve you better
Name
*
Email address
*
What age group do you belong to?
Select
Under 12
12-17
18-24
25 and above
What services are you interested in?
Please select at least one option.
Mental Health Resources
Suicide Prevention Programs
Anti-Bullying Initiatives
Gun Violence Prevention
Academic Success Programs
Cultural Pride Events
How did you hear about us?
Select
Social Media
Friend/Family
School
Community Event
Website Search
What is your preferred method of communication?
Please select at least one option.
Email
Phone
Text Message
In-Person
Are you interested in volunteering?
Select
Yes
No
Maybe
Which service or services are you interested in?
Please select at least one option.
Mental health support
Suicide prevention initiatives
Anti-bullying programs
Gun violence prevention
Additional questions or comments
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