1. How did you find out about AAC:

2. Do you Leave within the Lowell and the Greater Merrimack Valley? Yes No

3. What Town do you Leave in?

4. What part of AFrica do you come from : East Africa West Africa North Africa South Africa

5. Depending on the region Above please tell us your country of origin:

6. What other languages can you speak and can translate to English: Arabic Asante Baganda Creole Dinka French Grebo Shona Somali Swahili Twi Zwazi Zulu

7. Other language please specify:-

8. May we contact you with information about AAC's programs and Services Yes No

9. Depending on the Selection above Please provide your address below:

10. Do you have any suggestions for AAC Such as how to improve its programs and Services to the community:

Thank you for your Help. You can also contact as at the address below or email AAC
The AAC Board