2020-2021 Sourcebook Inclusion
Please complete this form to update your agency information or to be included in the next edition of the Community Council Sourcebook.
Email address *
Agency Name *
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Address *
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Mailing Address (if different)
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Phone *
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Alternate Phone
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Fax
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24 Hour Phone (if available)
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What is your website address? *
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Director Name *
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Director Title *
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Other Contact Name
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Other Contact Title
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Service Days (check all that apply) *
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Service Hours *
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Describe the services you provide (in 200 words or less). *
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Are your services provided to a specific geographic area (i.e zip code, city, school district)? If yes, please specify. *
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What is your target population (i.e. low income)? *
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Describe client eligibility criteria. *
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How does a client apply for services? *
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Is an appointment required? *
Is a referral required? If yes, from where? *
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Is the phone answered during normal business hours? *
Do you offer services in Spanish? *
If you offer services in any other languages, please specify.
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Is your location accessible by public transportation (i.e. DART)? *
Do you have any of the following resources for the disabled? *
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Years in operation. *
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State of Texas incorporation year. *
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Sources of funding (i.e. grant, donation, fees etc.) *
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Do you have sliding scale fees? *
Number of paid staff. *
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Number of volunteers. *
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By entering my full name and title below, I certify that the information provided on this form is an accurate and current reflection of this agency and its services. As the chief executive officer of this agency, I give permission to the Community Council to edit this information for use in the Council's copyrighted Sourcebook publication. I understand this information may also be available via the internet in digital form. *
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Date of Submission *
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