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