BASIC ORGANIZATIONAL INFORMATION

What is the name of the organization applying to be a WorkSource Connection Site?

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* 1. What is the name of the organization applying to be a WorkSource Connection Site?

Please identify the names and titles of all staff who will be assigned to the Connection Site.

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* 2. Please identify the names and titles of all staff who will be assigned to the Connection Site.

What is the email address for the primary contact?

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* 3. What is the email address for the primary contact?

Are you applying on behalf of an entire system (i.e. Seattle Public Library) or are you applying as a specific site (i.e. Seattle Public Library: Ballard Branch)?

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* 4. Are you applying on behalf of an entire system (i.e. Seattle Public Library) or are you applying as a specific site (i.e. Seattle Public Library: Ballard Branch)?

Does your organization currently have a website?

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* 5. Does your organization currently have a website?

If you have a website, what is the website address?

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* 6. If you have a website, what is the website address?

What is the physical address of the proposed WorkSource Connection Site? If you are including multiple locations, please provide all location details.

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* 7. What is the physical address of the proposed WorkSource Connection Site? If you are including multiple locations, please provide all location details.

What hours and days is your proposed site(s) currently open?

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* 8. What hours and days is your proposed site(s) currently open?

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