Service Provider Information Form
Based on the information provided, I understand the North Florida Inland LRTG will include this information in its approved database and will refer those seeking services as appropriate.
Person Providing Information (First & Last Name)
Agency - Organization Name
Agency - Organization Mailing Address
City or Township government
Faith Based Organization
Financial or Banking Institution (Bank, Credit Union, Trust Company, Mortgage Company Etc.)
Independent School District
Native American tribal government (Federally recognized)
Native American tribal organization (other than Federally recognized tribal governments)
Nonprofit with a 501c3 IRS staus, other than an institution of higher education
Nonprofit WITHOUT a 501c3 status with the IRS
Planning Council, Planning Organization, Councils of Government
Public and State controlled institution of higher education
Public Housing Authority / Indian Housing Authority
School, University, Private institution of higher education
Small Business and other For Profit Organization
Special District Government
Other - Please describe
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