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Program/Service Name
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Also Know As
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Physical Address
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Mailing Address
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Phone Number(s) - Ex: Main Number, Fax, Intake, etc. *
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Contact(s) who receives annual email update request. This person should be someone who is knowledgeable about the listing and likely to respond to an update request. Information will remain hidden unless otherwise requested. Please list: Name, Title, Phone Number and Email.
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Contact(s) who does Not receive update request. This person would be someone who might not be appropriate as a update contact but is still an important contact for the public. Ex: Director, Intake Coordinator, etc. Please list: Name, Title, Phone Number and Email.
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Description
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Website
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Hours
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Intake/Application Procedure - Ex: Bring photo ID and proof of income, Walk In, Call for more information or to make an appointment, etc.
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Fees - Ex: Fees vary depending on services, Free, etc.
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Eligibility - Ex: survivors of domestic violence, youth aged 13-16
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Geographic Area Served - Ex: Residents of Erie County, those living within zip code 14206
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Languages - Please list any languages you’re able to accommodate for non-English speakers or if you use translation services like Language Line
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Accessible to those with disabilities? Please list details if applicable.
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