To begin getting exposure to our community of volunteers, simply complete and submit the form below. We look forward to working with you!

Agency Name
Other Names For Agency (former, acronyms):
Affiliation: Are you affiliated with a larger organization? No    Yes Name of organization:
Address: What is the physical address of your agency? Street
City	State	Zip
County
Mailing Address: (If different from physical address) Street
City	State	Zip
Contacts: Main Phone Number	Toll Free Number
Director	Phone
Volunteer Coordinator	Phone
Donations	Phone
Fax	TDD
Contact Email
Website
Office Hours/Days
Service Description: Please list below those services you offer to anyone meeting your eligibility requirements. Callers are referred to your agency based on this description.
Eligibility: Who is eligible for your services?
Fees: What is your fee structure? No Fees Straight Fee (fee range) Sliding Scale Fee (fee range)
Insurance: Does your agency accept any private insurance or equivalent third party coverage? None Medicare Medicaid Private
Intake: What is your intake procedure/s? Referral Required (by whom) Walk-In Appointment
Counties Served: Barrow Clarke Elbert Franklin Greene Jackson Jasper Madison Morgan Newton Oconee Oglethorpe Stephens Walton Wilkes
Seasonal: Does your agency provide holiday assistance? No    Yes
Status: Please check the ONE answer that indicates your agency's organizational status. Governmental Not Classified Profit Membership Private Practice Religious Military Private Non-Profit Volunteer
Key Contact: Community Connection 211 would like to establish an ongoing relationship with a key person in your organization who can be contacted for updates and who will contact us when your organization has new information which might be important for us to have when referring callers to you. Please indicate the name, title, and phone number of this person. Thank you for your help.
Contact Name Title Phone
Volunteer Opportunities In which of the following areas can volunteers make a contribution in your organization?
Administrative/office Animal care/rights Arts & Crafts Board development Career counseling Childcare/daycare Clothes closet Companion/visiting services Counseling Fine and performing arts Food pantries Fundraising Health services Helpline counseling Holiday Assistance Immigration/refugee services Literacy/GED programs Maintenance/yardwork Mentoring Public relations/marketing Recreation and sports Servers/food preparation Skilled trades (painting, etc) Speaker's Bureau Special event assistance Training /education Translation Transportation/delivery Tutoring Other Please list other volunteer opportunities:
When do you have volunteer opportunities? Daytime Evening Overnight Weekends
Do you accept youth (ages 12-17) as volunteers? Yes    No Minimum age requirements
Do you accept groups as volunteers? Yes    No
Do you accept families with children as volunteers? Yes    No
Do you accept court-referred volunteers? Yes    No
Does your agency have seasonal volunteer opportunities for Thanksgiving, Christmas, or other holidays? Thanksgiving    Christmas    Other
Donations Does your agency accept ongoing, non-monetary donations in support of programs/services? Yes (please specify below)    No Clothing    Furniture    Household Items Large Appliances (televisions, refrigerators, stoves, etc.) Office Equipment
Is pick-up available? Yes    No
Hours for dropoff:
Days for dropoff:
Organization Description [Please limit to 75 words] Prior to submitting, please print this page using your browser's print button.
Thank you for taking the time to keep our information up-to-date!