Request edit access
Casa Hispana Interagency Partner Info
(requires Google sign-in)
Agency Information
Agency Name *
Contact Person *
Contact Person Email *
Street Address *
City *
State *
Zip Code *
Telephone *
Fax
Website *
Logo
Please provide us with your logo, if it can be a high resolution/ SVG image and transparent background it would be best.
Area of Service *
Please specify the geographical area of service of your organization
Client eligibility criteria *
Please specify any elgibility criteria the client/ family must meet to receive services or participate in programs of your organization.
Services/ Community Programs *
Please provide a list an explanation of the services you offer and programs ran by your organization to serve the community.
Services/ Community Programs for Hispanics *
Provide a list and explanation of services/ programs offered to the Hispanic community and/or in Spanish
Organization has a bilingual English-Spanish staff to provide direct customer service to Spanish-only speaking clients *
Required
Hours of operation *
Please provide your hours of operation by selecting your "Opening" and "Closing" hours per day of the week. If you are closed on a specific day, select "Closed". You may need to scroll left-right to access the hours. Just select the time when you open and the time when you close (only needed two choices per day of the week, unless you are closed).
Closed
06:00 AM
06:30 AM
07:00 AM
07:30 AM
08:00 AM
08:30 AM
09:00 AM
09:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
01:00 PM
01:30 PM
02:00 PM
02:30 PM
03:00 PM
03:30 PM
04:00 PM
04:30 PM
05:00 PM
05:30 PM
06:00 PM
06:30 PM
07:00 PM
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Other info regarding hours of operation
Type of Organization *
Select all that apply
Required
Documents: program brochures, forms, etc.
Please attach any program description brochures, intake forms, and other documents about your organization and services you offer which would be of service to member of the Hispanic community
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service