Your Location City where services are needed * County (if known) Please Select Clackamas Hood River Jackson Jefferson Josephine Klamath Malheur Marion Morrow Multnomah Polk South Marion Umatilla Wasco Washington Yamhill Other OCDC Site Location (if known) Your Contact Information Parent/Guardian Name * Preferred Language English Spanish Other Phone Number May we text this number? Please Select No Yes/Si Best time of day to reach you Please Select Morning Afternoon Evening Any Home Address Email Address Would You Like an Email Confirmation? Please Select No Yes/Si Your Family Information Is anyone in the family household pregnant? Please Select No Yes/Si Does family income come from work in agriculture? Please Select No Yes/Si Does the family receive public benefits? TANF SSI SNAP/Food Stamps Children Who Need Services Please add information about all your kids under the age of 5 that need our services. To add additional children, use the 'add child' button. Child's Name * Child's Date of Birth * Are there any concerns regarding your child's education? * Please Select No Yes/Si If you need any further assistance please contact your nearest OCDC location.