At PYD, we welcome and include people of all abilities, identities, and backgrounds. We believe that diverse and fully inclusive organizations empower individuals, heal communities, and create a better world for us all.

## Profile Details

First & Last Name (required)

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Phone Number

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Organization/Company/Agency

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Title/Role

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Mailing Street

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Mailing City

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Mailing State/Province

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Mailing ZIP/Postal Code

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Birth Month

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Birth Day

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Birth Year

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Gender Identity

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Languages Spoken Clear

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Other Languages Spoken (if not listed above)

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Race Clear

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Other Race (if not listed above)

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Ethnicity Clear

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Other Ethnicity (if not listed above)

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Household Income

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Self-identifies as having a disability?

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Developmental Disabilities Clear

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Intellectual Disabilities Clear

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Learning Disabilities Clear

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Physical Disabilities Clear

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Communication Disabilities Clear

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Sensory Disabilities Clear

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Mental Health Clear

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Health Conditions Clear

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Other Disabilities (if not listed above)

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Current Level of Education Clear

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If in school, does youth have an IEP or a 504 plan?

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Current Employment Status Clear

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Other Employment Status (if not listed above)

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Current Employer

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Length of Employment (with current job)

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How did you hear about PYD? Clear

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Please provide more detail on from who or where you heard about us.

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Do you provide transportation services?

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Do you help riders/customers identify mobility and transportation options?

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Why do you want to join MMC?

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What topics are you interested in learning about? Clear

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Other Topics (if not listed above)

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What skills or information can you share with the group? Clear

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Other Skills (if not listed above)

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