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2018 Health & Human Services Directory
Please fill out the following questionnaire to be included in the United Way of Charles County Directory
AGENCY NAME *
Your answer
AGENCY MISSION STATEMENT *
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AGENCY ADDRESS (include all sites) *
Your answer
DIRECTOR'S NAME & TITLE *
Your answer
PHONE & FAX (include all sites) *
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AGENCY WEBSITE
Your answer
AGENCY EMAIL CONTACT
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SERVICES OFFERED TO CLIENTS (include all sites if appropriate) *
Your answer
APPOINTMENT POLICY *
HOURS OF OPERATION(include days of week) *
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SERVICE AREA(S) *
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METHODS OF PAYMENTS *
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DOES AGENCY ACCEPT VOLUNTEERS? *
NAME & CONTACT INFORMATION FOR VOLUNTEER COORDINATOR, if any
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DOES AGENCY ACCEPT DONATIONS? *
WHAT TYPE OF DONATIONS ARE ACCEPTED, if any
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OTHER COMMENTS?
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