Home » Work Groups » Panhandle Continuum of Care for Housing & Homelessness » 2nd Annual Panhandle Project Connect » Panhandle Project Connect Service Application Panhandle Project Connect Service Application September 22nd, 2020 1 pm – 6 pm Guadalupe Center 1200 East 9th Street Scottsbluff, NE 69361 Your organization agrees to provide:Service delivery at the event from 1pm to 6pm Set up from 10am to 1pm Information about your services Organizations are encouraged to provide an immediate service or activity to engage participants on the day of the event Extension cords for access to electrical outlets if needed Number of individuals that will staff your booth the day of the event Each booth will be provided with one 8’ table and 2 chairsIndividual/Organization*Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact name*Contact email* Contact name*Contact email* Please check the boxes that best fit the services your agency is willing to provide the day of the event* Basic Needs – Clothing Vouchers Basic Needs – Public Benefits Veterans Services Education/Adult Elder Services Legal Assistance Financial Services/Credit Counsel Housing/Shelter Stabilization Minority/Refugee Services Basic Needs - Food Basic Needs – Hair Cuts Dental Care Education/Youth Employment Family Services Health Services Mental Health Substance Abuse Other Other services*Will you need access to an electrical outlet?*YesNoWill you need an internet connection?*YesNoWill you require any additional accommodations? (i.e. privacy screen, extension cord)*YesNoPlease explain*Project Connect and/or sponsors assume no responsibility for the safety of participants in this event. All participants recognize and agree by their participation that safety shall be their responsibility and hereby waive any right to see recovery for an injury or damage which may be incurred, either to person or property as a result of or in connection with this event or participation therein. I also give permission for my name and/or picture to appear in any media, including but not limited to, brochures, posters, newsletters, fliers and broadcast media.