1. First Name:
  2. Last Name:
  3. City where you live:
  4. County where you live:
  5. Email Address:
  6. Phone #:
  7. Best method to contact you:
  8. How did you hear about the workgroup opportunity?
  9. Have you reviewed the Illinois Child Support Services (CSS) Family 1ST Parental Workgroup (F1) charter or participated in an informational session?
  10. Are you interested in being a member of the F1?
  11. CSS is committed to engage with persons impacted by our program and policies, especially those representing marginalized communities, to obtain thoughtful, useful, and meaningful feedback. Please tell us why you are interested in helping CSS:
  13. Gender:
  14. Age:
  15. Education (All levels of education are welcomed and valued.):
  16. Annual household income:
  17. What is your language of origin?
  18. How do you identify your race/ethnicity?
  19. Are you a member of the LGBTQ+ community?
  20. Are you a current member of the military or a military veteran?
  21. Do you represent a community organization (formally or informally)?
  22. If yes, which organization?
  23. Do you consider yourself to be a member of any other group or population that experiences discrimination or exclusion? If so, please explain.
  24. Are you a parent who pays child support?
  25. Are you a parent who receives (or is supposed to receive) child support?
  26. Are you a grandparent or caretaker?
  27. Do you have a child support case being handled by the Office of Child Support, the Friend of the Court, or the Prosecuting Attorney?
  28. Can you attend and participate in workgroup meetings that will be conducted virtually?
  30. CAPTCHA

Demographic Information for Those Interested in Participating

We want to ensure the F1 is as diverse as possible. You can help by providing needed information below. Please provide only the information you are comfortable sharing. 

CSS does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs, or disability.  Any information shared to complete this form will remain confidential. The workgroup will make every attempt to make reasonable accommodations available to participants who request them.