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INFORMATION FORM

Community Services Directory
Listing Information Form
To print this form click on printer icon above menu.
Part 1
Program Name (if applicable)
Organization/Company Name

Location Address
Mailing Address
City/Island/Postal Code
Area Code
Telephone (s) & extensions
Emergency phone & hours:
Fax

E-mail
URL (Website)
Contact Name/Title (optional)
Part 2
Mission statement: (optional- please be brief, i.e.: less than forty words)
Sector:
___Public
___Non Profit
___Private
Employer Identification Number (EIN#), if applicable
Population served (i.e. elderly, youth, disabled, etc…)
Days and hours of operation:
(also include any emergency hours)
Services: Use bullet form (be clear and concise please)


Documentation/ information required from clients:
Special Events:
Fees: Are there fees associated with your services?
___ Yes ___ No
Funding: If fee for service, is there a funding source available to assist individuals?
___ Yes ___ No
Accessibility Are your premises wheelchair accessible?
___ Yes ___ No
Special accommodations available?
Other languages? ______Yes _____No If yes, list language(s):
Any other/ special information pertinent to the listing of your services?

Community Foundation of the Virgin Islands
PO Box 11790
St. Thomas, USVI 00801
FAX#: (340) 774-3852

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