Thank you for completing this survey about the needs of New Jersey families!

THIS SURVEY IS DUE NO LATER THAN Saturday February 29, 2020.

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* 1. Please rate the following programs. On a scale of 1 to 5 (with 1 being the Very Unsatisfied and 5 being the Very Satisfied), how satisfied were you with these programs?

  Very Satisfied Somewhat Satisfied Neutral  Somewhat Unsatisfied Very Unsatisfied  I have not used this Program
Early Intervention Services
Your County’s Special Child Health Case Management
Child Evaluation Center
Birth Defects and Autism Registry
Early Hearing and Detection Program (e.g. Deaf Monitoring Program)
Community Doula
Centering (Group prenatal care)
Breastfeeding
Fatherhood
WIC
Your SPAN Family Resource Specialist
Sexual education programs for teens
Nutrition education programs for youth/students
Physical activity programs for youth/students
Positive youth development programs
Oral Health
Childhood Lead
Smoking Cessation

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* 2. What is the most important thing families need to live their fullest lives?

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* 3. What are the biggest unmet needs of families in your community?

Please tell us about yourself.

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* 4. How would you identify yourself? (Check all that apply)

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* 5. What county in New Jersey do you live in?

Response to the following questions are optional.

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* 6. What is your age?

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* 7. What is your ethnicity?

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* 8. How do you identify your race? (Select all that apply)

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* 9. What is your current gender identity?

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* 10. We are interested in learning if you would like to participate in future activities (like focus groups or answering more in-depth surveys) or if you would like to be a part of choosing our statewide priorities, please give your contact information and we will reach out to you with more information about future opportunities.

                                                                    Thank you for completing the Survey!

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