Project Homeless Connect Buffalo 2020 - Virtual
Hello and thank you for your interest in Project Homeless Connect Buffalo 2020! In order to ensure everyone's safety and in observation of social distancing guidelines this year's event will be held remotely.

On November 19th, 2020 from 9am-5pm we are asking service providers to be available for homeless and at-risk clients to call your agency to learn about and get connected to services.

The information provided in this form will be collected and compiled into a brochure and delivered to homeless shelters across WNY in the days leading up to the event. 

We're also encouraging agencies and volunteer groups to collect and assemble personal care kits for clients. Personal hygiene has never been more important to our clients and the community while all donations of personal care items would be greatly appreciated, we are particularly in need of face masks, hand sanitizer, toothbrushes, toothpaste, shampoo, and soap.

Thank you all for your continued support of PHC Buffalo. Stay safe and be well!
Contact Person's Name
Contact Person's Telephone Number (direct telephone number and/or extension if possible)
Contact Person's Email Address
Agency Name
Agency Phone Number (phone number you would like shared in the outreach brochure and will be open on November 19th between 9am-5pm to assist homeless and at-risk clients). If you are just collecting personal care items for clients please put N/A.
Agency Services (as they relate to homeless and at-risk clients) Please check all that apply.
We will be collecting the following items. Please check all that apply. (Note we anticipate collecting items on November 2nd)
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy