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Individual Intake Form


Dear New Client,

Welcome to the Cooper Square Committee!

Click here to download our Individual Intake Form.

We prefer that you print it, fill it out, and scan and email back to the staffer who directed you to this page. If you do not have access to a printer or scanner, you may do the following:

      1. Print this Word Document.
      2. Replace applicable checkboxes with an “X”.
      3. Replace the blank next to “Applicant Signature” with your typed name.
      4. E-mail it back to the CSC staffperson who directed you to this page.

Thank you.