Northwest Hennepin Human Services Council

Guide Information Update Form

Organization Name
Submitted by
(First and Last Name)
Address
City
State
Zip
Phone
Fax
Email
Web address
Office Hours
Organization Description: Please provide a brief description of the organization
Service Description: Please provide a brief description of the agency?s program(s)
Languages: Which languages do you provide services in?
 English  Hmong
 Lao  Spanish
 Somali  Russian
 Ethiopian  Other
 
Eligibility and Enrollment: Please specify if there are any limits on eligibility for your services and how individuals enroll
Program Details: Please check the category(s) and subcategory(s) below that best describe your program
 Education
 Adult Basic Education
 Colleges & Universities
 Pre-Kindergarten
 Primary & Secondary School
 Faith Based
 Special Needs
 Other
If other, please describe
 Emergency Assistance & Resources
 Economic Assistance
 Food Shelf
 Housing
 Shelter
 Resource Centers
 Veteran Services
 Faith Based
 Special Needs
 Other
If other, please describe
 Employment
 Adult
 Youth
 Faith Based
 Special Needs
 Other
If other, please describe
 Ethnic-Based/Multi-Cultural Services
 Economic Assistance
 Education
 Employment
 Family Programs & Services
 Health Care
 Housing
 Immigration/Citizenship
 Interpreting/Translating
 Legal Resources
 Senior Services
 Transportation
 Youth Programs & Services
 Faith Based
 Special Needs
 Other
If other, please describe
 Family Programs & Services
 Child Care
 Crisis Support
 Parenting Programs
 Pre-Kindergarten
 Faith Based
 Special Needs
 Other
If other, please describe
 Health
 Chemical Health
 Dental
 Mental Health
 Primary Health Care
 Faith Based
 Special Needs
 Other
If other, please describe
 Legal Resources
 Advocacy/Education/Resources
 Immigration
 Legal Advice/Assistance
 Faith Based
 Special Needs
 Other
If other, please describe
 Transportation
 Public Transportation
 Seniors
 Vehicle Assistance Program
 Faith Based
 Special Needs
 Other
If other, please describe
 Senior Services
 Advocacy/Education/Resources
 Activities/Entertainment
 Health Education
 Housing
 Faith Based
 Special Needs
If other, please describe
 Youth Programs & Services
 After-School/Out of School Time Program (Enrichment)
 Employment
 Entertainment
 Informal/Open Activities
 Health Education/Promotion
 Mentoring
 Space Available for Youth Activities
 Sports/Recreation
 Support Services
 Tutoring (Educational)
 Special Needs
 Faith Based
 Other
If other, please describe
Youth Program Details: Please include the details of the program offered to youth at your agency.
Program Code(s)
Refer to this list for Program Codes:
1 After-School/Out of School Time Program (Enrichment)
2 Employment
3 Entertainment
4 Informal/Open Activities
5 Health Education/Promotion
6 Mentoring
7 Space Available for Youth Activities (free, unstructured)
8 Sports/Recreation
9 Support Services
10 Tutoring (Educational)
11 Faith Based
12 Special Needs
13 Other
Service Area
Age
Gender
Location
Day(s)
Time(s)
Other Criteria