Sign up for H.O.Y.A.S. Empath Name * First Name Last Name Are You a Kent County Resident? (If yes, please continue). Yes No Email * Phone (###) ### #### How many people are in your household? how many household members are age 0-5? How many household members are ages 6-17? How many household members are ages 18-64? How many household members are ages 65 or older? Are you employed? Yes No If you are employed, is it part time or full time? Part time Full time What is your family's annual income? Are you receiving food stamps or technical cash assistance? Food stamps Technical cash assistance Neither Are you receiving social security income? Yes No What is your race? What is your gender? If you have been convicted of a crime, briefly explain in the box below. Thank you for registering for H.O.Y.A.S. Empath. We will reach out to you shortly.
