Print Media Survey

Please complete the survey below to assist with statewide distribution
of NJ Parent Link printed materials.

Thank you.

Organization/Services Provided: (Please select one or more.)

Health Care
Behavioral & Mental Health
Child Care & Early Learning
Parent Education & Family Support
Professional Development & Resources

Number of printed materials your organization expects to use and/or distribute
to your consumers and stakeholders each year: (Please enter number for each item.)

NJ Parent Link Homepages
NJ Parent Link 2 x 3.5 Business Cards
NJ Parent Link 2 x 6 Bookmarks
NJ Parent Link 4 x 9 Rack Cards
NJ Parent Link 8.5 x 11 Flyers
NJ Parent Link 11 x 17 Posters
NJ Parent Link 30 x 46 Posters

Primary location for distribution of printed materials: (Please select one.)

Hospital (Labor & Delivery, Mother/Baby, NICU, SCN, Pediatrics)
Clinic (FQHC, WIC, Prenatal, Behavioral Health, Special Child Services)
Health Care Provider's Office
Child Care Center
Family Day Care
Elementary School
Middle School/High School
Post Secondary/College Campus
Professional Training Facility
Community Center
Place of Worship
Place of Business
Family Attraction
State Agency
County Agency
Municipal Agency
Community Organization
Private Practice

Organization Contact Information:

* Name:
* Email:
* Phone Number:

Organization Mailing Information:

* Contact's Name:
* Organization Name :
* Organization Mailing Address:
* City:
* State:
* Zip Code:

*For security purposes, please enter the 1st character (letter/number) of your email address :

*Required fields