CVI Help APP Organization Application
Approval/Confirmation of Org. Listing & What info. would your organization want listed on the APP.
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Email *
Organization Listing Permission *
Required
Organization Name *
Organization Address (Full) *
County *
Organization Phone # *
Emergency Hotline
Point of Contact *
Organization Website - (must include http:// or https://)
Public Email Address
Services Our Organization Provide *
Required
Is the organization open on Holidays?
If no, what holidays are you closed on?
If your organization provides medical services, please list the specific services here.
Age Range Our Organization Provides Services To *
Required
Gender Services Are Provided To *
Required
Directions & Parking Information *
Days of the week services are available *
Required
Hours of Operation *
Requirements for services provided *
More information regarding services provided *
A copy of your responses will be emailed to the address you provided.
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