Fatherhood First Eligibility Form Fatherhood First Eligibility and Intake Fatherhood First Enrollment Form Step 1 of 3 0% Date* Recruiter:Place of recruitment:Personal DataName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code County:*PhoneEmail Birth Date* Race*BlackWhiteAmerican IndianIsland PacificAsianOtherEthnicity*Non HispanicHispanic/LatinoUnknown What method do you prefer we contact you: *CellTextFacebookWhat is the best time to contact you?*What is your primary language?*Marital Status:*SingleMarriedDivorcedSeparatedWidowedDo you have any children under the age of two?*YesNoCurrent children's ages: Do you want to participate?*YesNoPlace of Recruitment (please include city):*Have you ever been erolled in the Fatherhood First Program?*YesNoWhen did you successfully complete the program?