Is Sembrando Semillitas right for me and my family?

Is Sembrando Semillitas right for me and my family?

Fill out this questionnaire to find out if our Culturally Responsive Home Visiting Program can support your child and family in the early development stages.

Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
What is your zip code? *
Hacienda CDC's Sembrando Semillitas program operates within Multnomah County, Molalla, and Canby limits.
Hacienda CDC's Sembrando Semillitas program is designed for pregnant families and their children under the age of four in Multnomah County, Molalla and Canby, OR. Based on your response, you are not eligible for this program because the zipcode you have shared is outside of this geographic area.
El programa Portland Niños de Hacienda CDC está diseñado para familias embarazadas y sus hijos menores de cuatro años en el condado de Multnomah, Molalla y Candy, OR. Según su respuesta, no es elegible para este programa porque el código postal que ha compartido está fuera de esta área geográfica.
What is your preferred language?*

SpanishEnglishOther
Are you currently pregnant or have a child under the age of four?*

YesNo
What is the age of your child?*
Is your family receiving home visits from any other agencies? (Select all that apply.)*

Early Head StartHealthy StartListo Para AprenderImpact NorthwestOther AgenciesNo
Why are you interested in Sembrando Semillitas?*

Early education for my childAccess a network of supportI am a new parentOther
What is your annual income?*
Ex: $30,000
How many people are in your household?*
Are you interested and able to participate in 2 home visits a month, virtually or in person?*

YesNo
Are you available to receive home visits Monday through Thursday between 9:00 AM and 4:30 PM?*

YesNo
Would you prefer to engage and connect with other families virtually or in person?*
What is the best way for Sembrando Semillitas to contact you?*

TextEmailPhone Call
What is the best time for us to contact you? *
How did you hear about Sembrando Semillitas?*

Direct ReferralHacienda CDC WebsiteOnline SearchWord of MouthOther Community Service AgencyI live as a resident in a Hacienda communityOther
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