2017 Southern Nevada Project Homeless Connect Booth Application
Please note the following important dates:

Booth Application Due by November 1st, 2017
Policies and Procedures Due by Weds, November 8th, 2017
Application and Tech Responses will be sent via email by November 3rd, 2017
MANDATORY All Provider Meeting will be held on: November 8th at 8:30am at Cashman Center in the Theatre.
Booth Set-up is scheduled for November 13th, 2017 from 1:00pm-4:00pm
PROJECT HOMELESS CONNECT is scheduled for November 14th, 2017 from 8:00am-4:00pm. Please arrive between 7:00am- 7:30am.

Please choose a service area (MUST fill out separate applications for each service area your agency choose to participate in) *
If your agency provides multiple services, please fill out a booth applicaiton for each service if you wish to have booth space in each service area.
Name of your organization *
Your answer
Each booth comes with 1 eight-foot long table and 2 chairs (unless otherwise specified) *
# of tables requesting
Your answer
# of chairs requesting *
Your answer
Electrical Needs *
Do you need electricity?
Internet Connection Needs *
Do you need internet connection? *Not guaranteed
Contact Person *
Your answer
Address *
Your answer
City, State, Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Please provide a very brief description of your organization (800 character limit) *
Your answer
Please provide a description of the programs or services that will be provided from your booth at PHC (800 character limit) *
Your answer
Will your organization be providing bus passes for follow-up appointments? *
Please list the names of staff persons who will be at your booth *
Your answer
Please provide the email address for each staff person from your agency attending the event (please check spelling carefully, so we can ensure they receive event information) *
Your answer
Please read and submit the separate Policy and Procedure Agreement. Copy and paste this link into your web browser for quick access: https://goo.gl/forms/myQmbMOXIqQC3YOH3 Or visit www.NevadaHomelessAlliance.Org. The agreement MUST be signed and submitted prior to the application's approval. *
ALL individuals from your organization who will be present at PHC MUST sign and submit P&P document.
Never submit passwords through Google Forms.
This form was created inside of nevadahomelessalliance.org. Report Abuse - Terms of Service - Additional Terms