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211 Agency
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Agency Name (ANSWER BELOW)
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Your answer
Agency Description (ANSWER BELOW)
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Your answer
Does your agency provide services during Public Safety Power Shutoffs (PSPS) or disasters?
We anticipate ongoing services will be available during a PSPS event
We plan to provide additional services during PSPS events or during disasters (please note below)
We do not plan to provide additional services during PSPS or disasters
Not sure
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Please list any additional services your agency may provide during a PSPS event or disaster.
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Main Agency Location
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Your answer
Description of Location
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Mailing Address
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Your answer
Hours of Operation
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Your answer
Disabilities Access
Fully accessible to individuals using mobility aids
Potential limitations to access – call for details
Service area is not accessible by wheelchair
Designated, accessible parking spaces
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What Bus Service Can They Take To Get To Your Location
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Disability Access
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ADA accessible
Not wheelchair accessible
N/A
Agency Main Number
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Agency Main Email
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Agency Website URL
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Agency Main Contact Name and Email
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Your answer
Agency Senior Administrator Name and Email
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