Father's First Name
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Father's Last Name
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City/State you live in?
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Contact Number
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Email
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Are you single, in a relationship, or married?
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What do you currently do for a living?
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How many children do you have that you support?
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How many people do you support in your household?
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What are some things you need for your child/children's back to school?
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Do you have reliable transportation?
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Tell me about yourself and what you strive to do for your family?
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How did you hear about Robert Coffee?
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