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Community Partners

Bold indicates required fields

E-Mail Address
Organization Name
Contact Name
Contact Phone Number
Organization Street Address
Organization City
Organization Zip Code
Parish
Type of Organization
Non-Profit
Faith Based
Governmental
Business
Other
Do you serve people outside your Parish?
Yes
No
Do you currently serve the public or just a select client base?
Public
Select Client Base
Level of DSS Support You are Interested in Providing: (All levels require a computer with Internet access available to clients.)
Gold (Provides assistive service)
Silver (limited assistance)
Bronze (Self-Service site)
What are your hours of operation?
Do you have Internet access where you plan to serve clients?
Yes
No
Briefly describe your organization's mission and what services you currently provide to clients
What equipment is currently available for client use
Computer
Phone
Fax Machine
Copy Machine
Computer Printer
Other

Check all that apply