Family Connect 2018 Booth Application
Family Connect
Family Resource and Health Fair
Hosted by the Nevada Homeless Alliance and the Mobile Health Collaborative

Wednesday, April 11, 2018 from 2:00 pm to 7:00 pm
Cambridge Recreation Center
3930 Cambridge Street
Las Vegas, NV

- Please submit one application per booth.
- Booth applications must be received by Friday, March 30, 2018 at 5:00 pm. No late applications will be accepted.
- Booth applications will be reviewed and verified for accurate information and to ensure services rendered are applicable to this population.
- Signed Policies and Procedures Agreements must be signed by every staff member that will be in attendance and received no later than Thursday, April 5, 2018 at 5:00 pm and can be accessed at:

- If approved for participation, at least one representative from your organization MUST ATTEND the All Provider Meeting at Cambridge Recreation Center on Wednesday, April 4, 2018 from 10:00 am to 11:00 am.
- Set-up is on April 11, 2018 from 12:00 pm - 1:00 pm. All booth providers must arrive and complete set-up during this time.
- There will be a pre-event pep rally at 1:30 pm that you are encouraged to attend.

- Each booth includes one table and two chairs. Organizations may decorate their booth however they choose (including table clothes banners, flyers and backdrops, etc.), explaining the agency and its purpose for attending the event.
- Technology (phone, internet, or power) is available, but not guaranteed.
- Booths must remain open and be staffed from 2:00 pm – 7:00 pm. Please have enough representatives and assistance in attendance to ensure this will happen.
- Organizations/individuals must supply their own sign(s).
- No inappropriate solicitation is allowed. This includes offering services that cannot be rendered; are misleading regarding the services that will actually be provided; or that could be harmful to the participants or take advantage of the participants' situation.
- No food can be given from booths, including candy.
- You may not offer giveaways at your booth(s). Giveaways must be distributed through the “Connect Store".
- Only participants are eligible to receive services. Booth representatives and volunteers cannot receive any services.

- Booth teardown is from 7:00 pm - 8:00 pm. Please ensure that you have staff available to participate in event teardown. Before you leave, you must pick up all trash in and around your booth, breakdown your table, and stack your chairs. All information and left-over products must be either thrown away or taken with you.
- If you are able, please provide assistance in tearing down the rest of the event.
- An electronic survey may be sent to all booth staff with regard to follow-up and feedback for the event. Please use the survey as an opportunity to express what went well, what aspects need to be improved on, and offer suggestions for future events.

Service Area *
A separate registration must be complete for each service area that your organization chooses to participate in.
Organization *
Your answer
Contact Person *
Please separate multiple contacts with a comma.
Your answer
E-mail *
Please separate multiple addresses with a comma.
Your answer
Phone Number *
Please separate multiple numbers with a comma.
Your answer
Organization Address *
Your answer
City, State, Zip Code *
Your answer
Description of Organization *
Please be brief. *800 character limit
Your answer
Description of Services to be Provided *
Please list the services your organization will be providing at the event in BULLET FORMAT. *800 character limit
Your answer
Tables Requested *
How many tables will your organization require? Please be conservative as supplies are limited. Each table will include 2 chairs.
Electricity *
Will your organization require electricity?
Internet *
Will your organization require internet connectivity? *Not guaranteed
Bus Pass Provision *
Will your organization be providing bus passes to participants for follow-up appointments?
Names of Staff Attending *
List the names of your organization's staff that will be in attendance to provide services. Please separate names with commas.
Your answer
E-mails of Staff Attending *
List the e-mails of your organization's staff that will be in attendance to provide services. Please separate e-mails with commas.
Your answer
HMIS/CMIS Account *
We will be recording participant data in HMIS/CMIS. Does your organization have an HMIS/CMIS account with Bitfocus?
Volunteers *
Student volunteers will be available to assist at booths. Are you interested in having a student volunteer assigned to your booth? If yes, indicate the field of study you prefer (e.g. nursing, medicine, social work, psychology, translation, etc.).
Your answer
Follow-Up *
After the event, volunteers will be following up with participants who agree to be contacted. Would your organization agree to be part of our follow-up network. In other words, may we facilitate communication between your organization and participants regarding follow-up care?
Policies & Procedures Agreement *
Please read and submit the Policies and Procedures Agreement. ALL staff from your organization that will be in attendance MUST sign and submit the Policy and Procedure Agreement. The Policies & Procedures Agreement can be accessed at:
Never submit passwords through Google Forms.
This form was created inside of Report Abuse - Terms of Service - Additional Terms