United Way of Central Kentucky 2-1-1 Survey

Agency Overview

Please note that responses cannot be saved and submitted at another time. If you would like to view all questions and complete the survey electronically through Microsoft Word, please visit http://www.unitedwayck.org/2-1-1.

Agency participation in 2-1-1 is voluntary and free. Upon receipt of this survey, the information will be entered into the 2-1-1 database for public access. Please ensure appropriate approval channels at your organization are followed prior to submitting your information. United Way is a convener of resources but does not provide direct service to individuals. A referral through 2-1-1 is not a guarantee of service, which may be provided by agencies per their guidelines and policies. Inclusion of an organization in the 2-1-1 system is not an endorsement of any agency by United Way.

Question Title

* 1. Name of Organization.

Question Title

* 2. Is your organization already in the 2-1-1 system?

Yes

Do not know.

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* 3. Other names or abbreviations for organization.

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* 4. What is your address?

Number:

City:

County:

State:

Zip Code:

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* 5. What is your phone information?

Central:

Administrative:

Fax:

Other:

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* 6. What is your postal address?

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* 7. What are your hours of operation?

Administrative:

Intake: