This form gives us information on the participant and their parent or guardian. We need this in order to hold any coaching session or begin the process of connecting you to the MSC-T Program. If you are uncomfortable providing this information in the form, please let us know by sending an email to Marina at [email protected]. We will identify a way to gather the information that works for you.

Please understand we treat all information provided as confidential. We will never sell your contact information or share it with anyone who is not staff of this program. Lastly, we will only use the contact information you provide to communicate with you.

Your answer to this question does not affect your eligibility to participate in the program.