Connecting Fathers, Connecting Families
Pre-screening Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you a Father or Father figure?
*
Yes
No
**This is includes Biological, Custodial, Legal, Adoptive, Foster, Stepfather, Grandfather, Non-relative Male, or Male family member serving in the role of Father to a dependent child or children
Best way to contact you.
*
Phone Call
Text Message
Email
Select the Florida County that you live in.
*
Osceola County
Lake County
Sumter County
Volusia County
Putnam County
None of the above
Are you currently receiving any of the following?
*
TANF (Temporary Assistance for Needy Families)
SNAP (Food Assistance/EBT)
Re-employment Assistance
None of the above
Have you been incarcerated in the last 5 years or are currently involved with the justice system?
*
Yes
No
Do you have a child support order or owe back child support?
*
Yes
No
Are you currently participating in any of the following programs?
*
Batterers Intervention Program (BIP)
Parenting Classes
Family Court or DCF Involvement (Chapter 39)
None of the above
Would you like support with any of the following?
*
Finding a job
Managing child support
Reentry or justice system support
Accessing healthcare
Parenting/Co-parenting help
Child development understanding
Submit
Should be Empty: