Partner Profile: Application and Update

Partner Profile: (Agency Application and Update)

Inclusion Criteria
Agency Information
Agency Contact Information
Administration Office Hours
Signature

I AUTHORIZE THE USE AND VERIFY THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE. I UNDERSTAND THAT IN ORDER TO KEEP 2-1-1 SAN JOAQUIN’S (211SJ) DATABASE ACCURATE AND UP TO DATE, AGENCIES ARE ASKED TO INFORM 211SJ OF CHANGES TO THE AGENCY’S OPERATIONS WITHIN 30 DAYS AND TO PROVIDE CURRENT INFORMATION DURING OUR ANNUAL UPDATE PERIOD. I HAVE READ AND UNDERSTOOD 211SJ’S INCLUSION/EXCLUSION POLICY. APPLICATIONS/UPDATES WILL BE PROCESSED WITHIN 7 DAYS OF RECEIPT.

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PARTNER PROFILE: APPLICATION AND UPDATE

2-1-1 is committed to ensuring that all information in the database is accurate and up-to-date.

Please complete this form for the initial application and to inform us of any changes in your agency/business profile or download the form here. Completed forms may be sent by email to 211SJ@frrcsj.org or by fax to (209) 461-3087 Attn: Data Specialist.

If you have any questions, please call (209) 461-2926 or email 211SJ@frrcsj.org.