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YWCA Cares Program Information Form

HomeYWCA Cares Program Information Form

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YWCA Cares Program Information Form

YWCA knows many families are experiencing difficulty finding and affording childcare for infants, toddlers, and school-age children during COVID-19. The YWCA Cares program aims to provide no-cost childcare to families in need for a variety of reasons. This form will assist Team YWCA in determining family needs and how we can support you.

Name/Nombre*
First Last
Address/Su dirección*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone/Número de teléfono*
Email/Correo electrónico*
Are you an employee of the City of El Paso?/¿Trabaja para la ciudad de El Paso?*
- Yes
- No
Do you reside within El Paso city limits?/¿Vives en los límites de la ciudad de El Paso?*
- Yes
- No
Are you any of the following?/¿Usted es alguno de los siguientes?*
- A veteran currently living in Texas/Un veterano que vive en Texas
- Pharmacy or healthcare worker/Trabajador de farmacia o sanitario
- Local or state government worker/Trabajador del gobierno local o estatal
- Restaurant or food delivery worker/Trabajador de restaurante o repartidor de comida
- First responder/Primer respondedor
- Gas station employee/Empleado de la gasolinera
- Childcare/home health provider, or other caregiver / Proveedor de cuidado de niños / salud en el hogar u otro cuidador
- Mail/delivery worker / Trabajador de correo/entrega
- Military personnel/Personal militar
- None of the above/Ninguna de las anteriores
How many children between the ages of 0-12 currently live with you? Please list their ages. / ¿Cuántos niños de 0 a 12 años viven actualmente con usted? Indique sus edades.*
How did you hear about the YWCA Cares Program? (Select all that apply)/¿Cómo se enteró del Programa Cares de la YWCA? (Seleccione todas las que correspondan)*
- Social media/Redes sociales
- News media/Noticias
- Email/Correo electrónico
- Moms on Board
- Word of mouth (friend, family, etc.)/El boca a boca (amigo, familia, etc.)
- Received notice in the mail/Aviso en el correo
- Radio commercial/Comercial de radio
- Employer/Empleador
- Flier/El folleto
- TV commercial/Comercial de televisión
- Other/De otra manera

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