Screening Tool

Prescreening Questionnaire

Are you a resident of the state?

Yes No

Are you a US Citizen or Eligible Non-Citizen?

Yes No

Are you the primary caretaker for a child under age 19 living in your home?

Yes No

Are you under the age of 19?

Yes No

Are you pregnant?

Yes No

Have you been diagnosed with breast or cervical cancer?

Yes No

Were you in Foster Care at the time of your 18th Birthday and between the ages of 18 to 26?

Yes No

Click "Submit" to get the results!

Disclaimer: This tool is provided for fun and informational purposes only. It is not officially endorsed, guaranteed to be accurate, or intended for commercial use. The creator assumes no responsibility or liability for any use of the tool or its results.