For Service Providers

Please fill out our Agency Main Form and one Service Form if you are interested in having your agency in the United Way 2-1-1 Database. Physical forms can be provided upon request. Please review our Inclusion Criteria before proceeding.

Agency Main Form

Service Forms
If for whatever reason these designations seem too narrow for your organization’s services, please fill out this General Service Form to give greater clarity to the service provided to the community.

 For any questions or concerns, please contact our Manager of 2-1-1, Mark Madison, at

Thank you for partnering with us to better serve Northeast Georgia.

Please do not include any organization or program information that you do not want released to the public. 
All information we request is optional and should be provided at your discretion. We reserve the right to edit your information.
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