EHS Grant Question Title * 1. Do you have a child or children ages 6 weeks-36 months old? Yes No Question Title * 2. If you answered "yes" to question 1, please indicate the age(s) of your child/children. Question Title * 3. Do you have a need for structured child care, with excellent health and nutritional services or possibly any other services parents may request? Yes No Question Title * 4. If you are employed or a student, how many days and/or hours per week would you require childcare to meet your job related or educational needs? Question Title * 5. Do you have the ability to transport your child or children to the center? Yes No Question Title * 6. Would you be willing to accompany your child to the program; in which you would receive training and educational instruction which would assist you in the job market? Yes No Done