GRCCT Intake Form

We're excited to have you join our programming here at GRCCT. You or your guardian may complete the following form. 

I am interested in (Check all that apply)

These are the days I am available (Check all that apply):


Gender Identity


Racial/Ethnic Identity

Parent/Guardian Information:
Alternate Contact Information:
Education Information:

Are you eligible for any of these services? (Check all that apply)

Please contact us with any questions at 616-254-7736 or
We look forward to connecting with you! 
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