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Intake Form

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Fill out the form below to begin the intake process. A member of our team will then reach out to you with further details and next steps. 

Do You Currently Reside in Battle Creek?
Yes
No
Are You A New Hire or Current Employee?
Current Employee
New Hire
Is Your Current or Future Employer a Participant of the Battle Creek TRAIN Program?
Yes
No
Unsure
Do You Identify As One or More of the Following?
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