O ur primary goal is to give assistance to the Prince George's County community, but we also need your help.  If you know of a family or individual in need of assistance we need to hear from you.  If you're able to lend a hand in our mentoring or assistance programs or financially contribute to our activities, we need to hear from you as well.
* = required field.

Name*
Address*
Address (cont'd)
City*
State*
ZIP / Postal Code*
Phone*
E-mail*
	I am interested in: (select all that apply)
	Stretch-To-Vote Program
	A Gift For You Program
	Look Up, Look Back Mentoring Program
	Making a Financial Contribution in the amount of: $
	Referring a Family / Person for Services
Tell us a little about this party and how we might assist them. You may add other comments here also.