If you have a program or service related to the Coronavirus. Please fill out the form below. 211 Community Resource Directory This form allows your organization to add resources or services to the 211 directory related to the Coronavirus. Agency/Organization Name*Program/Service Name*Site Location of Program*Site name, addressContact Name*Name of contact person for program.Contact Information*Phone Number and EmailService(s) Listing of Program*(e.g. counseling services, food pantry, temporary shelter)Please provide brief description of program*Program Eligibility Criteria*Who is eligible for this program? Are their any restrictions, financial requirements, etc.?Are there fees?*No FeeFlat FeeIf Flat Fee, What's the amount?If the Fee is a sliding scale, specify the range.Payment Types Accepted Medicaid Medicare Private Insurance Scholarships Available What are your intake procedures? Walk-In Call for Appointment Referral Required What languages are spoken by your staff?* English Spanish Other If other language, please list below.Service Area*Please list the area(s) the program serves. If different sites serve different locations, please indicate that. (Service areas can be a wide variety of things such as zip code, city, county, statewide, or nationwide. Please be specific so that referrals are accurate).Required Documentation* None Required Driver's License Social Security Card Birth Certificate Proof of Residence/Utility Bill Pay Stub/Proof of Income Eviction Notice Hours of Operation*Please let us know the hours and days this program is open.Is this program seasonal?*YesNoIf seasonal, provide start and end date below.Areas of Publication* Phone Online 2-1-1 is available over the phone and Online. Which of these mediums would you like this program to be listed in?
