Family Success Center - Interest Form

Family Success Center - Interest Form
The goal of the Family Success Center is to help individuals and families located in the Greater Greensboro area. We focus on the following pillars: Career Readiness, Education, Financial Literacy, and Health & Wellness. Our program goal is to help all members find a sustainable career. Please complete this brief interest form and an FSC staff member will follow up with you within the next 24-48 business hours/ We look forward to having you join FSC!!
How did you hear about us?*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Is this a mobile phone?

YesNo
What services are you seeking from the Family Success Center?*

Academic Development (Ex: GED completion, Financial Aid assistance, Secondary enrollment assistance, Referrals for sponsorships for Workforce Training Programs, etc.)Career Development (Ex: Job readiness assessments, Career Planning, Computer Skills Workshops, Resume assistance, Mock Interviews, Referrals to FSC Employment Partners, etc.)Financial Literacy (Ex: Budgeting, Debt counseling, Banking/Saving, Investing, etc.)Health & Wellness (Ex: Yoga, Zumba, Health & Nutrition workshops, Parenting, etc.)
Are you employed? *
All members must have an employment goal (Ex: A job, A better job, or A career). Do you agree with this goal?*
Employment: Where is your current status?*
The following questions are only asked to determine if you may need additional resources/support. It does not determine eligibility for enrollment into the FSC.
Do you have health insurance?
Do you have adequate transportation? *
Do you have a valid driver's license? (You do not need a driver's license to be a FSC member) *
Do you have adequate/safe housing?*
Do you currently live in a Greensboro Housing Authority (GHA) property?*
Do you have enough food each month?
Do you receive SNAP or TANF, etc.?
Do you have childcare?
FSC works with a variety of community partners and organizations. Please check the areas in which you may need support/referrals to other organizations for yourself and/or others IN YOUR HOUSEHOLD.*

Workforce Development/Job PlacementParenting Education and SupportPost Secondary Education (ex: getting a certification in areas such as healthcare, HVAC, Forklift, CDL, etc.)Transportation (ex: learning how to ride a bus, assistance getting driver's fees reduced, tutoring for getting driver's license, etc.)Health & WellnessFinancial LiteracyPrograms for child(ren) Ex: Mentoring groups, sports groups, etc.
Best Way to Connect With You *
If you choose OTHER, in the previous question please type who or what program referred you to the FSC below.
Should be Empty:

Family Success Center - Interest Form

The following questions are only asked to determine if you may need additional resources/support. It does not determine eligibility for enrollment into the FSC.