Eligibility Intake Form

Working From Waitlist

We are always accepting referrals, but often work from a waitlist.

SEPTEMBER 2024

Anchorage: Working for waitlist.

SafeRoot Anchorage: Working from waitlist.

MatSu Valley: Working from waitlist.

Interested in Services?

Please complete this form to the best of your ability. A member of our team will be in touch to schedule a Needs Assessment to discuss programming, options, and resources. Make sure your contact information is correct, we won't be able to chat without it!

Name*

Email (please double check spelling)*

Phone (please double check the number is correct and in service)

What region are you living in? MatSu, Anchorage, or Other (please list).*

Gender Identity/Relationship Orientation

Age (Choosing Our Roots provides services for youth ages 13-24)*

I understand all regions are currently working from a waitlist.*

I understand that someone will respond to me within five business days.*

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Choosing Our Roots

907-764-6233 info@choosingourroots.org

Privacy Policy

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Send Mail To:

3905 Carolina Dr #54

Anchorage AK 99517

info@choosingourroots.org

volunteer@choosingourroots.org

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