Hope In Action Intake Form – Hope In Action

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About Us
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Events
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Intake Form

Hope In Action Intake Form

Thank you for reaching out to Prince Georges County Hope In Action. Please fill out this quick survey and someone will contact you with 24-48 business hours to set up services.

Name of Client

If you aren't the client, what is your relationship to them?

Parent Gaurdian Other

Email

Address

What city do you reside in?

Suitland/ Shadyside District Height's Temple Hills Prince Georges County Other:

Phone Number

Date Of Birth

Ethnicity

Hispanic Non-Hispanic

Client Place of Birth

Maryland Washington DC Virginia Other:

Which of our free services are you interested? (Check all that apply)

Youth Program Group Therapy Mental Health Therapy and Counseling Substance Abuse Therapy Re-entry Program Other:

The Hope In Action Anti-Violence Project is led by Director Rev. Tony Lee and Prince George’s County Office of Community Relations Director Euniesha Davis. Dreams Work 501c3 is the fiscal agent.

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CONTACT HOPE IN ACTION

Dreams Work
8201 Corporate Drive Ste.
620 Landover, MD 20785

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