YMCA
Kiwanis

1. Agency / Organization Name

Please list all other names your organization may be known as, including acronyms, abbreviations, etc; for example, HNNCSB, H-NNCSB, Hampton-Newport News CSB.

2. Coalition/Network Affiliations

Check all that your organization is a member of:

3. Agency/Organization Description.


Example: The Helping Agency is a non-profit organization helping people with basic needs of emergency shelter, stable housing, food, clothing, and linkage to ongoing services. Eligibility is based on low-income and proof of residency. 		500(characters remaining)

4. Agency Main Address, Phone, Fax, Website & E-Mail Address

  (to be shown on KPO website)
Contact Person for annual updating

5. Agency Director Information


Will NOT be published--Internal KPO use only.

6. Localities Served

Please select all localities that your agency serves below:
  
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7. General Fee Information

Check all that apply:

8. Volunteer Opportunities

  

9. Service Categories

IMPORTANT: Please indicate service categories for ALL SERVICES and PROGRAMS offered by this organization.

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10. Program Data

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