Father Project Intake form

Individual interested in receiving services

*

Is it okay to text you?

Yes

No

What services are you seeking? (check all that apply):

Employment Services

Parenting Groups

Child Support

Other:

Are you working with Child Support?

Yes

No

Are you working with Child Protection?

Yes

No

Are you currently employed?

Yes

No

Have you been unemployed during the past 6 months?

Yes

No

Were you released from incarceration within the last 6 months?

Yes

No

Are you making a referral to the FATHER Project from MFIP or CPS?

Yes

No

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