FFL Parent Application

Date

First Name

Last Name

Email address

Address

City

Zip

County

Cell#

Please list one emergency contact. Include full name and phone number.

United Way of Greater Atlanta would like for program participants to tell us about how our services are affecting them and their families through the use of simple surveys. The surveys will be conducted throughout the program. If you decide to participate in the surveys, you will be asked to answer questions about yourself, your family and what you are learning in the sessions. If you choose to participate in the surveys, your identity will be kept confidential; no identifying information will be shared with anyone outside of this program. Note that your privacy will be protected. Your information will be combined with all other participants. Your honest answers help us improve services for all families, including yours. Surveys are required as part of your participation in the program.

I give United Way of Greater Atlanta permission to videotape and/or take photographs of me. I understand that all photographs and videos become the property of United Way and that the photographs and videos may be published in educational books, articles, materials, supplemental products, on the United Way website and social media platforms including but not limited to Facebook, Instagram, Twitter, LinkedIn, etc.

Please add any questions or comments.