Inquiries Online Form

Thank you for your interest in Hands Across The Water.  A staff person will reach out to you soon to follow up.  

*As an agency, we are constantly working to improve our services to all of our clients. We collect demographic information to assist us in establishing goals, maintaining accountability, and for contract and accreditation reviews. The data is tracked in aggregate form (not individually). There is always a "prefer not to answer option" available for any field you prefer not to share with us.

Applicant 1 Ap 1 Legal First Name* Ap 1 Preferred Name Ap 1 Legal Middle Name Ap 1 Last Name* Ap 1 Race/Ethnicity* American Indian or Alaska Native Asian Black or African American Hispanic, Latino, Latinx, or Spanish Origin Middle Eastern or North African Multiracial/Other Native Hawaiian or Other Pacific Islander Prefer not share/did not share White or Caucasian   Ap 1 Gender* Male Female Non-binary/genderqueer Genderfluid Agender Other Prefer not to answer   Ap 1 Transgender* Yes No Prefer not to answer   Ap 1 Preferred Pronouns* Ze/Hir They/Them Ze/Zir He/Him She/Her Prefer not to share   Ap 1 Sexual Orientation* Heterosexual/straight Homosexual/gay/lesbian Asexual Pansexual Queer Questioning Bisexual Other Prefer not share/did not share   Date of Birth* Contact Preferred Contact Method* Home Phone Home Email Ap 1 Email Ap 2 Email Ap 1 Work Email Ap 2 Work Email Ap 1 Cell Phone Ap 2 Cell Phone Ap 1 Work Phone Ap 2 Work Phone   Home Phone ()-ext Enter Int'l Number Home Email* Ap 1 Email* Ap 2 Email Ap 1 Cell Phone* ()-ext Enter Int'l Number Ap 2 Cell Phone ()-ext Enter Int'l Number

Applicant 2 Ap 2 Legal First Name Ap 2 Preferred Name Ap 2 Legal Middle Name Ap 2 Legal Last Name Ap 2 Race/Ethnicity American Indian or Alaska Native Asian Black or African American Hispanic, Latino, Latinx, or Spanish Origin Middle Eastern or North African Multiracial/Other Native Hawaiian or Other Pacific Islander Prefer not share/did not share White or Caucasian   Ap 2 Gender Male Female Non-binary/genderqueer Genderfluid Agender Other Prefer not to answer   Ap 2 Transgender Yes No Prefer not to answer   Ap 2 Preferred Pronouns Ze/Hir They/Them Ze/Zir He/Him She/Her Prefer not to share   Ap 2 Sexual Orientation Heterosexual/straight Homosexual/gay/lesbian Asexual Pansexual Queer Questioning Bisexual Other Prefer not share/did not share   Date of Birth Residence Address Street Address* Street Address Line 2 City* State/Region* AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Zip Code* County* Country United States Australia Cambodia Canada China Ethiopia France Germany Guatemala India Ireland Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries

Save Submitting...