Program Info Collection Form
Please submit your information
via e-mail or regular postal mail.
E-mail address of contact person: (required)
Call Collect: Yes No
Phases or levels of program:
Ages you accept:
Which classification(s) best describes this type of program:
Counseling Center Induction Center
Which of the following do you accept:
Male Female Juvenile Battered Women
Emotional Problems Pregnancy Crisis Runaways Sex Offenders
Length of Program:
Requests Preliminary Screening Application for Program Entry: Yes No
Requests Missing Link newsletter subscription (free): Yes No
Print and complete the above form, and return it to The Missing Link, Inc.
Regular Postal Mail:
Director of Placement Services
The Missing Link, Inc.
P. O. Box 40031
Cleveland, OH 44140-0031
Please send us a few brochures describing your program so we can use them for referral.
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