Legal Clinic: Provider Host Request
Are you a service provider who would like to host the Clinic? Fill out this form below and we'll get in contact with you to work out the details
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What organization would be hosting the clinic?
Location where the clinic would be hosted? *
Name of point of contact at the organization *
Phone number *
Email *
What day(s)/time(s) would you prefer to have the clinic on?
Morning
Afternoon
Evening
Anytime!
Monday
Tuesday
Wednesday
Thursday
Friday
Weekends
Clear selection
Any other questions or information you'd like us to know
Submit
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This form was created inside of Rhode Island Coalition to End Homelessness. Report Abuse
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