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Sign-Up for Family Reading Partners
Your Full Name
(Required)
Are you eligible for Medicaid?
(Required)
Yes
No
Are you a resident of Orange County, NC?
(Required)
Yes
No
Thank you for your interest.
At this time, our program is only available to families living in Orange County, NC. If you have questions or would like to learn about literacy services available in your area, please feel free to email us at info@familyreadingpartners.org
Contact Information
Street Address
(Required)
City
(Required)
Zipcode
(Required)
Email Address
(Required)
Phone Number
(Required)
How would you like to be contacted?
(Required)
Phone Call
Text Message
Email
What is the main language you speak at home?
(Required)
English
Spanish
Other
Do you feel comfortable receiving services in English, or would you prefer an interpreter?
I am comfortable with English
I need an interpreter
Your Child's Information
Please fill in the information for your child aged 4 or younger.
Child Name
(Required)
Child Date of Birth (Month, Day, Year)
(Required)
Child's Gender
Male
Female
Prefer Not to Say
Do you have additional children 4 or younger in the home?
(Required)
Yes
No
Child Name
Child Date of Birth (Month, Day, Year)
Child's Gender
Male
Female
Prefer Not to Say
Child Name
Child Date of Birth (Month, Day, Year)
Child's Gender
Male
Female
Prefer Not to Say
Do you have any school aged children (5 and older) in your home?
(Required)
Yes
No
Additional Children's Names and Ages
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