New Customer Registration Form

Welcome!

Our Purpose:

Our purpose is to be a beacon of hope and a catalyst for change, providing minority residents with the resources, support, and guidance they need to rebuild their lives. We are committed to treating every individual with the dignity and respect they deserve, ensuring their journey to self-sufficiency is met with compassion and understanding.

Our Mission:

Our mission is to offer a holistic support system that addresses the multifaceted needs of minority residents. We provide education, shelter, counseling, job training, and access to essential services, all tailored to empower individuals to overcome the barriers of homelessness. By addressing both immediate needs and long-term goals, we aim to equip residents with the tools and confidence to achieve stable, independent living, and to break the cycle of poverty.

How did you hear about us?

Full Name*

First NameLast Name

Address*

Street Address

CityState

Zip Code

Phone Number*

E-mail*

example@example.com

*Please fill out this section: List down household member to attend the event:

	First Name	Last Name	Age	Relationship
1
2
3
4
5
6

Please provide specific details on topic:

What other programs are you interested in?*

Will you be willing to recommend a us?

YesNoMaybe

Our Vision:

Our vision is a future where every minority woman has access to safe housing, quality healthcare, employment opportunities, and the support she needs to reintegrate into society successfully. We aspire to create a community where no woman is left behind or forgotten.

**Someone from our department will contact you soon, Thank You!**

The C Institute

Non-Profit Organization

info@thecinstitute1.org

www.thecinstitute1.org

(800) 961-2118