Client Interaction Form
Due to Covid-19, this form must be filled out each time a Cooperative Extension staff member comes in contact with a client. The client can fill out this form on their phone OR the staff member can use their own device to fill out the form for the client.
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Extension staff member you had primary contact with: *
First & Last Name *
Phone Number *
Email Address
Gender
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Hispanic or Latino
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Race
Clear selection
Thank you!
Submit
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