Participant Eligibility Questions


Please answer the below questions honestly, this will determine your eligibilty for our program.



1.      Are you 21 years of age or older?

Select one:





2.      Are you currently pregnant?

Select one:







3.      Have you resided in Pinellas, Pasco, Hillsborough, or Manatee Counties for at Least 1 Year?

Select one:





4.      Do You Have Minor Children that Reside With You?

Select one: