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Local FSNs Services Resources Search About Us  

Agency Suggestion

Please review our Inclusion/Exclusion policy before submitting an agency. Before being added, It will be reviewed by a resource specialist. Below is a contact information form, please fill out as many fields as possible. Thank-you!

1.
Permission
FSN-NC has permission to publish your information in its directory of services (including online directory and links).
Yes
No
2.
Name
Address Info  
Address Line 1:
Address Line 2:
City:
State:
Zip:
County:
Mailing Address If different from above.
Address Line 1:
Address Line 2:
City:
State:
Zip:
Phone Info  
Business Phone:
Area
3 Digit
4 Digit
  
Ext:
Toll Free Phone:
Fax:
TTY Phone:
After Hours Phone
Internet Info  
Email:
Web Page:
please exclude the "http://" text
3. Description  
    Please describe your organization. This information will appear on our website's searchable database.
4. Service Info  
Ages Served:
  Intake Procedures:
Call for appointment Walk In
Must be referred by agency: (Agency Name)
Hours of Operation:
5. Service Area  
   

Please list counties served or indicate entire state, national or international

International National All of North Carolina
Not in NC: Please list the location you serve:
Alamance Alexander Alleghany Anson
Ashe Avery Beaufort Bertie
Bladen Brunswick Buncombe Burke
Cabarrus Caldwell Camden Carteret
Caswell Catawba Chatham Cherokee
Chowan Clay Cleveland Columbus
Craven Cumberland Currituck Dare
Davidson Davie Duplin Durham
Edgecombe Forsyth Franklin Gaston
Gates Graham Granville Greene
Guilford Halifax Harnett Haywood
Henderson Hertford Hoke Hyde
Iredell Jackson Johnston Jones
Lee Lenoir Lincoln Macon
Madison Martin McDowell Mecklenburg
Mitchell Montgomery Moore Nash
New Hanover Northhampton Onslow Orange
Pamlico Pasquotank Pender Perquimans
Person Pitt Polk Randolph
Richmond Robeson Rockingham Rowan
Rutherford Sampson Scotland Stanly
Stokes Surry Swain Transylvania
Tyrell Union Vance Wake
Warren Washington Watauga Wayne
Wilkes Wilson Yadkin Yancey

 
6. Services  
Please list the services provided by your organization. (For example, counseling, respite care, tutoring, support groups)..
7. Service Population
Do you serve a particular population of people with specific disabilities, diseases or special needs? Please list (examples: at-risk teens, children with autism, families of chronically ill children, people who are mentally ill)

separate each listing with a comma (,)
8. Support Groups
Do you offer support groups?
No
Yes. If yes please list in the box below (For example, cancer survivors, cancer caregivers, single dads, mothers of multiples, people with a specific disability.)
9. Financial Assistance
Do you provide financial assistance?
No
If yes, please describe types of assistance and eligibility requirements (for example: camp scholarships, prescription assistance for uninsured, emergency rent assistance for families making less than ___ )
10. Service Fee
Do you charge a fee for your services?
No
Yes. If yes, please elaborate (for example, sliding scale fees, accept Medicaid, etc)
11. Serving non-English speaking clients
Are you equipped to serve non-English speaking clients?
No
Yes - If yes, how and for which languages.
Interpreter on staff
Languages
By appointment or advance notice
AT&T language line
Please list name of person who speaks Spanish:
12. Personnel  
Please provide the following information for the Director of your organization:
Name:
Phone:
Email:
    Please provide the following information for the update contact for your organization:
Same as Director (no need to fill out the info below)
Name:
Phone:
Email:
   
    Your corrections will be reviewed before we add them to our database. We may contact you by phone or e-mail if we have any questions:
Same as Director (no need to fill out the info below)
Same as Contact (no need to fill out the info below)
Entered By:
Title:
Phone:
Email:

 
© Family Support Network of North Carolina, 2003