BAC: Sign In Sheet

Please ONLY SIGN-IN TO THE BAC ONE TIME PER DAY After signing in once, it brings you right back to this screen but please DO NOT sign-in again, use the address box at top right of screen to go to your web destination (ex. type www.gmail.com or www.yahoo.com or www.google.com in the address box then press enter to log-in and read your emails or do your Web search)

Please feel free to ask staff to assist you if help is needed.

Contact Information

First Name
(Nombre) *

Last Name
(Apellido) *

Email
(Correo electrónico) * 🛈

Phone
(Teléfono) * 🛈

Have you ever been a participant of any of our Services?
(¿Alguna vez ha estado en nuestro Program de Autosuficiencia econónica o nuestro programa de empleos?) *

Yes

No

Housing Provider / Supportive Services Agency
(Proveedor de Hogar / Agencia de servicios de soporte) *

Other:
(Otro) *

Purpose of your visit to BAC today?
(Propósito de su visita al BAC este día) *

Other:
(Otro) *