Power Bag - Literacy Coalition of the Permian Basin

Name *

First

Last

Phone number *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Which Hospital was your child born in? *

When did you first look through your POWER Bag? *

How familiar were you with the importance of reading before reviewing the information in the POWER Bag? *

What is the highest level of formal education that the child’s mother or father received? *

What is your yearly income as a family? *

As a parent, do you need help with reading resources? *