Pre Attendance Survey

PRE ATTENDANCE SURVEY

Art & Healing Cohort 6-Week Program

NO. 2

* Indicates required field

Name *

First

Last

[object Object]

What is your age *

What is your address *

Line 1

Line 2

City

State

Zip Code

Country

Which online platform did you hear about art & healing cohort 6-week program *

Facebook Instagram Twitter Other

IF OTHER PLEASE SPECIFY *

Or did you hear about this program from *

Print Advertisement Friend Pop Up & Play ( Community) Workshop 97.5 FM KDEE "Full Circle w/ Ms. Wanda Other

If Other please specify: *

Have you experienced art & healing before? *

YES NO

Why do you want to particpate in this Art & Healing Cohort 6-Week Program now? *

Submit

Proudly powered by Weebly