New Client Intake
Welcome to the Elmore County Family Resource Center. 
Please complete this form so we can help connect you with the appropriate programs and resources.

Information disclosed to the Elmore County Family Resource Center will only be used to provide appropriate services.
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Todays Date
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Name *
First and last name
Phone number *
Email
Address, Street, City, State, Zip code *
Age
Date of Birth
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Gender *
Race and/or Ethnicity (check all the apply) *
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Number of people in household
Number of adults in the home
Number of children in the home
Monthly Income *
Services Needed:
Any information you think would be helpful for us to better serve you? *
Current Services being provided by ECFRC
How did you hear about Elmore County Family Resource Center?
How would you like us to reach out to you? *
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