Check Screen Reader Mode to make this survey compatible with screen readers.
Check Screen Reader Mode to make this survey compatible with screen readers.

Within My Reach - Relationship Workshop Series 2026-2027

Within My Reach - Relationship Workshop Series

Within My Reach is a skill and decision-making program for helping individuals achieve their goals in family and marriage relationships. The program allows you to learn how to have healthy, happy relationships with those in your life.
1.What is your name?(Required.)
2.Contact information(Required.)
3.Number in household(Required.)
4.How many children are in your family?
5.Which of the following best describes your current relationship status?(Required.)
6.Referral Source - if referred
7.Which race/ethnicity best describes you? (Please choose only one.)
8.Do you receive TANF?
9.Are your children enrolled in Head Start/Early Head Start?
10.Are you a former Head Start parent?
11.Last four of your social (for identification purposes only)(Required.)
12.Your date of birth
Date 
13.Are you currently employed?
14.What is your annual income?(Required.)
15.What is the highest level of school you have completed or the highest degree you have received?
16.What do you hope to learn from this workshop?
Current Progress,
0 of 16 answered