Assistance Request for: &nbsp;<img src="//www.tfaforms.com/forms/get_image/192826/846236c017af781f8245944f6817b2d9-Copyofblack-transHTHlogo.png" alt="Hack the Hood" width="500" style="max-width: 100%;">

The person responsible for this form has provided the following contact information:

If you have any questions about this form, please contact us at info@hackthehood.org. 

Feedback welcome!