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Painted Brain | New Employee Accounts Creation Request
We're bridging communities and changing the conversation about mental illness using arts and media.
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New Employee Accounts Creation Request
Employee's Full Name
*
County Gender (Los Angeles County Request)
Female
Male
Self-Identification
Female
Male
Non-binary
Other
Ethnicity (Los Angeles County Request)
Black/African American
Hispanic/Latino
Asian
American Indian
Filipino
White
Self-Identification Ethnicity (Painted Brain Request)
Staff or Manager?
Staff
Manager
Secondary Email
*
Email to be Created
*
Confirm Email
Temporary Password
*
Employee's Bio (Optional)
Employee's Professional Photograph/Selfie (Optional)
Upload
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