Benefit Access for Victims of Domestic Violence
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Registration Form

Wednesday, February 15, 2012

BENEFIT ACCESS FOR VICTIMS OF DOMESTIC VIOLENCE

Hampden Family Center
1104 W. 36th Street
Baltimore, MD 21211

10:00 AM—1:00 PM

Our Presenters:

Stephanie Hawkins, Special Initiatives Team Policy Specialist Maryland Department of Human Resources Family Investment Administration Office of Programs

Rhonda Wicks and Pat Waddy, of Johns Hopkins WIC

Laura Flamm, Nutrition Associate at Maryland Hunger Solutions

There is NO FEE for this training.

Inclement Weather Policy
The Hampden Family Center follows Baltimore City Public Schools’ inclement weather policy relating to closings, delays and early dismissals. If Baltimore City Schools are cancelled or delayed for February 15, then our training will be cancelled and rescheduled (at the same time and location) for Wednesday, February 29, 2012.

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1. Please enter your contact information:

Please enter your contact information: Name:
Organization:
Address:
Address 2:
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2. In case of cancellation due to inclement weather, we may need to contact you in the evening or at home. Please provide an emergency contact number where we could reach you, such as a home phone, cell phone, personal email, or your work email (if you have remote access):

In case of cancellation due to inclement weather, we may need to contact you in the evening or at home. Please provide an emergency contact number where we could reach you, such as a home phone, cell phone, personal email, or your work email (if you have remote access):

3. (Optional) What specific questions do you have about the Food Supplement Program (FSP)? (For example, eligibility questions, specific issues you've had with victims who tried to access FSP etc.)

(Optional) What specific questions do you have about the Food Supplement Program (FSP)? (For example, eligibility questions, specific issues you've had with victims who tried to access FSP etc.)

4. (Optional) What specific questions do you have about Temporary Cash Assistance (TCA)? (For example, eligibility, access to benefits, specific issues that victims have had with TCA, etc.)

(Optional) What specific questions do you have about Temporary Cash Assistance (TCA)? (For example, eligibility, access to benefits, specific issues that victims have had with TCA, etc.)

5. (Optional) What specific questions do you have about the Women, Infants, and Children (WIC) program? (For example, questions about eligibility, access to benefits, or specific issues victims have had with WIC)

(Optional) What specific questions do you have about the Women, Infants, and Children (WIC) program? (For example, questions about eligibility, access to benefits, or specific issues victims have had with WIC)

6. (Optional) What specific questions do you have about using the Service Access Information Link (SAIL) to help clients sign up for FSP or TCA benefits? (For example, questions about eligibility, access to benefits, or specific issues victims have had with SAIL) Is your organization interested in learning how to receive federal reimbursement for FSP outreach activities?

(Optional) What specific questions do you have about using the Service Access Information Link (SAIL) to help clients sign up for FSP or TCA benefits? (For example, questions about eligibility, access to benefits, or specific issues victims have had with SAIL) Is your organization interested in learning how to receive federal reimbursement for FSP outreach activities?

7. (Optional) Are there other additional questions that you have regarding nutrition programs or state program benefits that you'd like the presenters to address?

(Optional) Are there other additional questions that you have regarding nutrition programs or state program benefits that you'd like the presenters to address?

Thanks for registering for "Benefit Access for Victims of Domestic Violence"! We look forward to seeing you at the training. There is limited space for this workshop, so if you can no longer make the training, please contact us at 301-352-4574 or email info@mnadv.org.

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