2016 Service Provider Participation Form

Project Homeless Connect is pleased to announce that we will again be holding  in Watsonville on November 18th at the Veteran's Hall. 

Please complete this form to verify your participation in the November 18, 2016 Watsonville Connect event to be held at the Watsonville Veterans Memorial Hall.

The deadline for submitting this form is November 1, 2016. Participation is not guaranteed and will be determined by the Watsonville Connect organizing committee. Direct service providers are encouraged to apply. Fees for services are prohibited and conditional service delivery is strongly discouraged. 

* 1. What is your agency/organization's name?

* 2. Is your organization a...

* 3. What service will you be providing on November 18, 2016?

* 4. How you would you categorize the services you will be providing?

* 5. How many people from your organization will be attending PHC to provide services?

* 6. What is the estimated dollar value of your contribution to PHC, including your staff time?

* 7. Does your service require anything that you cannot provide on your own? (e.g. WI-FI  electrical chords, etc)

* 8. On the day of the event, how many of the following items will you need?

  1 2 3 4 5
Tables - 6 foot
Tables - 8 foot
Electrical Outlets
Wi-Fi internet access

* 9. Who will be the primary contact for Watsonville Connect?

* 10. Email Address

* 11. Phone Number

* 12. Is your agency able to make a monetary donation to help with event costs?

Report a problem