Skip to content
Family Support Center Plus Interest Survey
*
1.
Name:
(Required.)
*
2.
Email Address
(Required.)
*
3.
Phone Number
(Required.)
*
4.
Are you a Howard County Resident? (You must be a Howard County Resident to Participate in this program)
(Required.)
Yes
No
*
5.
Have you ever visited or attended an event at the support center?
(Required.)
Yes
No
*
6.
Do you have a child age birth - 5 years old?
(Required.)
Yes
No
*
7.
A family support center staff member will reach out to you to complete the enrollment process. How would you prefer to be contacted?
(Required.)
Phone Call
Email
*
8.
How did you find out about our program?
(Required.)
Parent Pages Newsletter
Website
Word of Mouth
Community Outreach Event
Referral from Community Agency ( Judy Center, Infants and Toddlers, DSS, HCPSS)
Email
Other (please specify)
*
9.
Why are you interested in enrolling at the Family Support Center?
(Required.)