Program Description Form for Yuma County Resource Guide
Thank you for taking the time to complete this description program form. The information you provide will be used to create Yuma County's Free Resource Guide. Please fill this form for each program within your agency. If you have any questions or would like to provide additional information please contact Program Coordination Specialist, Francis Martinez at (Office) 928.343.3020, (Mobile) 480.528.2399 or  fmartinez@firstthingsfirst.org

Feel free to share this form with other program handlers within your agency or with other agencies that provide services within the Yuma Region.

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Agency Name
Program Name
Program's Point of Contact
Office Phone Number
Alternate Phone Number
Office Address
Email
Program Category
Please select the best category for the program - not your agency.
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Program Social Media Presence
Please provide a direct web link to the program if possible, and name of program in social media (Facebook, Instagram, Twitter, etc.) if any.
Brief Program Description
In a brief summary, please describe the services provided by the individual program (not agency).                                     (Maximum of 500 Characters)
What age demographic is the program serving?
What region/s are covered by the program?
Eligibility requirements for the program?
What documents (if any) are needed to receive services?
Please list documents clients would need to be assisted by the program. For example: birth certificates, immunization records, pay checks, W2s, 1040 tax forms, utility bills, proof of residency and/or citizenship, etc.
Are there any fees or cost associated with the program?
If yes, please list the cost or fees of the program.
Is financial assistance available for clients? If so, please describe client requirements.
Please indicate what language/s the program is available in? (Please check all that apply)
What are the general operation hours for the program?
Is there an answering service for office/program?
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