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September 15th Member Agency Orientation (09/15/25) at 10:00am
Please complete the form below before you or your employees register for our orientation
on Monday, September 15 2025. Completion of this form is required for attending a Member Agency Orientation.
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* Indicates required question
Email
*
Your email
Agency Name
*
Your answer
Main Contact Name
*
Your answer
Main Contact Title
*
Your answer
Main Contact Phone Number
*
Your answer
Main Contact Email (if different from above)
*
Your answer
Agency Address
*
Your answer
Agency Website
*
Your answer
Organization's EIN
*
Your answer
Mission Statement
*
Your answer
Type of Organization
*
Education
Government
Non-profit
Other:
Tell us more about your organization and the folks you support.
*
Your answer
Who from your organization will be referring clients to DFSO? If possible, please provide both name and email!
Your answer
What are some other programs and/or organizations you refer clients to?
Your answer
What are upcoming opportunities for us to better get to know your organization? (i.e. open houses, events, fairs, etc)
Your answer
A copy of your responses will be emailed to the address you provided.
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