APPLICATION FOR SERVICES

Application Criteria

Mothers 25 and under

Mothers without a College Degree

I Currently Receive

WIC

SNAP

HOUSING

MEDICAID

Highest Level of Education

Currently Enrolled in High School

GED

High School Diploma

Employment Status

Unemployed

Part-Time

Full-Time

Parent Permissions

I give FAFMC permission to post myself and child(ren) on social media

I do not give FAFMC permission to post myself/child(ren) on social med

I give FAFMC permission to give photos of myself/child(ren) to donors

I do not give FAFMC permission to give photos of myself/child(ren)

I give FAFMC permission to use the first name of my child ONLY

I prefer FAFMC to use "Baby (first initial)" Example Baby S

The applicant is a minor. I am completing the application as her parent/guardian. I give FAFMC permission to serve my minor child and her infant.

I understand services are provided quarterly. I understand I may or may not receive services quarterly. I understand I may or may not receive all items I list on the wish list.

Thanks for submitting!

Little Rock, AR, USA