Pop-Up PHC 2018 Service Provider Application
Pop-Up Project Homeless Connect is typically held on the third Tuesday of the month. Please join us for this mobile, collaborative event that aims to provide essential services to our community members experiencing homelessness.

2018 Pop-Ups:

- January 16, 2018 - The Courtyard @ 1401 North Las Vegas Boulevard, 9:00 am - 3:00 pm - REGISTRATION CLOSED
- February 20, 2018 - The Center @ 401 South Maryland Parkway, 10:00 am - 2:00 pm - REGISTRATION CLOSED
- March 20, 2018 - The Center @ 401 South Maryland Parkway, 10:00 am - 2:00 pm - REGISTRATION CLOSED
- April - NO POP-UP (see above for information on Family Connect)
- May 15, 2018 - The Salvation Army @ 35 West Owens Avenue, 11:00 am - 3:00 pm - REGISTRATION CLOSED
- June 19, 2018 - The Salvation Army @ 35 West Owens Avenue, 11:00 am -3:00 pm - REGISTRATION CLOSED
- July 17, 2018 - The Center @ 401 South Maryland Parkway, 10:00 am - 2: 00 pm - REGISTRATION CLOSED
- August 21, 2018 - The Salvation Army @ 35 West Owens Avenue, 11:00 am - 3:00 pm
- September 18, 2018 - TO BE DETERMINED, 10:00 am - 2:00 pm
- October 16, 2018 - The Center @ 401 South Maryland Parkway, 10:00 am - 2: 00 pm
- November - Project Homeless Connect, No Pop-Up
- December 2018 - TO BE DETERMINED

Registrants will receive informational e-mails in the weeks prior to the event.

Service Category *
Select the category that is most closely associated with the services your organization will be providing.
Dates of Participation *
Indicate the date(s) you would like to provide services. Select all that apply.
Required
Organization *
Your answer
Contact Person *
Your answer
Contact E-mail Address *
Your answer
Contact Phone Number *
Your answer
Tables Requested *
Chairs Requested *
Electricity *
Will your organization require electricity? *We will make every effort to accommodate requests, however, access to electricity is not guaranteed.
Internet *
Will your organization require internet access? *We will make every effort to accommodate requests, however, access to internet is not guaranteed.
Mobile Unit *
Will your organization be providing services from a mobile unit?
Bus Passes *
Will your organization be providing bus passes for follow-up appointments?
Service Description *
Provide a brief description of the services your organization will be providing. *Your description will be published in a service directory to be distributed to participants and providers at the event.
Your answer
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