Project Homeless Connect is hosting its first event on October 6th, 2017 in Salt Lake City. We invite your business, or professional organization to participate. 

Please complete the form below to get started.


 

Participant Information Form

Please complete one form for each individual service/program that your agency will be providing. This information is important for planning purposes, especially for those agencies providing a wide range of services and information.

Contact Person *
Contact Person
Address *
Address
Contact Phone Number *
Contact Phone Number
Please indicate the category (or categories) that best describe your service at our event:
Average Time of Individual Service Being Provided:
Average Time of Individual Service Being Provided:
**Tables, chairs, pipe and drape will be provided. All other equipment, materials, etc. are the responsibility of the provider. The Salt Palace will provide Wi-Fi and access to electricity.**

Please indicate any specific needs you have in order to provide your service:

Download the above form (.pdf) if you prefer to complete by hand. Email, fax or mail back to the address below. Contact Abigail Mower with questions, 801-535-7174 or email Abigail.Mower@slcgov.com.

City & County Building
451 South State Street, Room 404
PO Box 145486
Salt Lake City, Utah 84114-5486