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CHOICE TO CHANGE INC.
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Improving and Empowering
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Contact us
First name
*
Last name
Email
*
Phone
*
Court Case Number
Parent/Guardian (if applicable)
Participants Date of Birth
Month
What service(s) are you in need of?
*
Community Service
Court Ordered Juvenile Course
Court Ordered English Adult Course
Court Ordered Spanish Adult Course
Other
Please select all that apply
How many hours of community service (if applicable)
How can we assist you?
*
Submit
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