Family Support Center Plus Interest Survey Question Title * 1. Name: (Required.) Question Title * 2. Email Address (Required.) Question Title * 3. Phone Number (Required.) Question Title * 4. Are you a Howard County Resident? (You must be a Howard County Resident to Participate in this program) (Required.) Yes No Question Title * 5. Have you ever visited or attended an event at the support center? (Required.) Yes No Question Title * 6. Do you have a child age birth - 5 years old? (Required.) Yes No Question Title * 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 Question Title * 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) Question Title * 9. Why are you interested in enrolling at the Family Support Center? (Required.) Question Title * 10. Are you able to attend events at the family support center 3-4 times per month? (Required.) Yes No Done