Agency Form

If you have new information to be added to our database, please complete the information below to provide the Resource team the necessary information to process your application. 

Michigan 2-1-1 has established criteria to scope the Inclusion / Exclusion of resource information in our database. To view that criteria, click here.

Contact Information
Agency Information
Is this organization classified 501(c)(3)?
Agency Director Contact Information
Prefix
Title
Additional Contact Information
Prefix
Title
Accessibility
Funded By
(Provide a 2-5 sentence description of the organization, its mission, and its activities)
(Describe the area that this agency services; may be defined by ZIP Codes, cities, counties or state names)
(i.e., located on the NE corner of State Street and Main Street, across from the gas station)
(Describe the agency's hours of operation)
Program Information
(Provide a detailed description of the service offered)
(Describe eligibility requirements a person must meet to receive this service)
(Describe the application process)
(Include any fees and how a person may pay for services rendered)
(Other than English, what languages are consistently available)