Strengthening early childhood services RECORD Name *Surnames *Telephone numbersEmail *Town *How is your living area considered: *UrbanRuralDo you receive the services of Avanzando Juntos (AJ)? *YeahNoDo you receive services from the Healthy Families of Puerto Rico (FSPR) program? *YeahNoWhich category best describes you? You can check more than one. *FamilyDisabled personAdvancing Together Representative Representative of Healthy Families of Puerto Rico OtherOther:My education is: *Elemental schoolMiddle SchoolHigh schoolVocationalPost secondaryOther:If you answered "Other" in the previous question, specify your educational level:My race is: * WhiteAfrican AmericanNative AmericanAsianTwo races or moreI don't want to disclose itOtherOther:My ethnicity is: * Hispanic or LatinaNot Hispanic or LatinoI don't want to disclose itOther:Reasonable accommodation:Diet restrictions:I agreeI understand that the activity will be at the Royal Sonesta Hotel, Isla VerdeSend
