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SCC Program Registration
Welcome to Syracuse Community Connections! Our mission is to work with individuals, families, and communities to promote health and well-being through prevention, intervention, and education. Please register bellow to begin enjoying our services.
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* Indicates required question
Participant First Name (for individual participating in program)
*
Your answer
Participant Last Name (for individual participating in program)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Parent/Guardian First Name ( Please type N/A if not applicaple)
*
Your answer
Parent/Guardian Last Name ( Please type N/A if not applicaple)
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Which program are you registering for?
*
FACES (HIV & AIDS services)
Healthy Start (Parent & child services)
Mainstream ( Youth and young adults with developmental disabilities services)
SNUG (Anti-gun violence services)
Youth and Family Services
Supported Employement Program ( Career planning assistance)
Senior Services (Senior Day Program)
Senior Services (Medical Transportation)
Would you require transportation assistance? (Specific to certain programs)
*
Yes
No
Would you require food assistance? (Specific to certain programs)
*
Yes
No
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