Screen Reader Mode Icon
Please fill in your information below so we can stay in touch.

Thank you!

Question Title

* 1. What is your name?

Question Title

* 2. What is your organization/business name?

Question Title

* 3. What is your agency/office phone number?

Question Title

* 4. Provide personal phone number if that is how you prefer to be contacted (optional)

Question Title

* 5. What is your mailing address?

Question Title

* 6. What is your email address?

Question Title

* 7. Ages served (if applicable)

Question Title

* 8. Brief overview of services provided

Question Title

* 9. Coverage area (county/counties)

Question Title

* 10. How are your services accessed? Online, phone, in-person, referral only?

Question Title

* 11. Do you have criteria for accessing services (if applicable)? If so, what are those criteria.

Question Title

* 12. What are your funding sources?

Question Title

* 13. Where do you see an opportunity for partnership?

Question Title

* 14. Do you see duplication of services that could be streamlined or consolidated?

Question Title

* 15. What is your preferred method of communication (rank)

Question Title

* 16. Any other thoughts, feedback, etc?

Question Title

* 17. Email headshot or photo to unitedwaycentralks@hotmail.com (reply to email that included link to this survey)

0 of 17 answered
 

T