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DOMESTIC VIOLENCE RESOURCE FAIR
 COMPLETE THIS SURVEY AND BE REGISTERED TO WIN A $100 GIFT CARD!

Please help us to understand how we can better serve the families in our community by completing this survey. 
In order to be entered into the prize drawing, you must answer all questions.
All information is confidential and your personal contact information will not be shared with any other organizations/businesses or mailing lists.
YOU WILL ONLY BE CONTACTED IF YOU ARE A PRIZE WINNER OR YOU REQUEST CONTACT.
1.PLEASE PROVIDE YOUR CONTACT INFORMATION - CONTACT INFORMATION NEEDED TO NOTIFY WINNERS.(Required.)
2.ETHNICITY(Required.)
3.AGE(Required.)
4.RELATIONSHIP STATUS(Required.)
5.FAMILY SIZE (YOU, YOUR PARTNER, THE CHILDREN THAT LIVE WITH YOU IN YOUR HOME)(Required.)
6.AGE OF CHILDREN IN YOUR HOME - CHECK ALL THAT APPLY
7.MONTHLY FAMILY INCOME(Required.)
8.DO YOU CURRENTLY  HAVE ANY OF THE FOLLOWING? CHECK ALL THAT APPLY.(Required.)
9.HOUSING STATUS.  (Required.)
10.ARE YOU OR YOUR PARTNER IN OR HAVE SERVED IN THE ARMED FORCES?(Required.)
11.DO YOU HAVE A CHILD WHO HAS A DEVELOPMENTAL DELAY OR DISABILITY?(Required.)
12.HAVE YOU OR YOUR PARTNER EVER USED OR CURRENTLY USE ALCOHOL OR DRUGS?(Required.)
13.DO YOU OR YOUR PARTNER CURRENTLY USE TOBACCO?(Required.)
14.HOW HAS COVID 19 AFFECTED YOUR FAMILY? CHECK ALL THAT APPLY(Required.)
15.HAVE YOU OR YOUR PARTNER EVER RECEIVED OR CURRENTLY RECEIVE SERVICES FROM CHILD WELFARE SERVICES/CHILD PROTECTIVE SERVICES (CPS)?(Required.)
16.ARE YOU CURRENTLY RECIEVING SUPPORT FROM ONE OF THE FOLLOWING MFSS PROGRAMS (CHECK ALL THAT APPLY).
17.WOULD YOU LIKE INFORMATION ABOUT THE FOLLOWING RESOURCES? PLEASE CHECK ALL THAT APPLY.(Required.)
18.MAY WE CONTACT YOU TO PROVIDE INFORMATION/RESOURCES?(Required.)
Current Progress,
0 of 18 answered