masterADAS

Working in Partnership to Prevent and Treat Substance Use Disorders for Lorain County Individuals and Families since 1989

Data Correction Form

In order to assure that the information in the YouthPages is

comprehensive and correct, this form can be used to add a

program to our database or to report a change in information

such as new address, etc.

Fill out the correction form and submit.

Thank you for your help!!

4950 Oberlin Avenue, Lorain, Ohio 44053,

Phone: 440-282-9920 Fax: 440.282-9928

Name of Organization Requiring Correction
Describe Correction
About You:
First Name
Last Name
Organization
Phone #
E-Mail