West Virginia Statewide Resource Guide

West Virginia Statewide Resource Guide
Business/Organization Name*
Business/Service Type*

Case ManagementClinicalClothing AssistanceCommunity-Based Organization (CBO)Disease Vaccination/Testing/Treatment Services (e.g. - HIV, Viral Hepatitis)Financial Assistance ServicesFor-ProfitFree ClinicGroup PracticeHard Reduction ProgramHospitalHousing Opportunities for People With AIDS (HOPWA)Housing Services (e.g. - Rent/Mortgage Assistance, Temporary/Permanent Housing, Shelter)Job Placement/Career ServicesLegal ServicesLinkage to CareLocal/County Health DepartmentMobile ClinicNon-ClinicalNonprofitNutritional Services (e.g. - SNAP, Food Pantry/Bank)Private PracticeReferral ServicesRyan WhiteSexually Transmitted Disease/Infection Testing/Treatment (STD/STI)Telehealth/TelemedicineTranslation ServicesTransportation ServicesUrgent CareOther
Resource Type*

HIVSubstance/Opioid Use Disorder (SUD/OUD)Viral HepatitisOther
Other Resources Offered*
Please list any other resources you provide that are not connected to HIV, Viral Hepatitis, or SUD/OUD services
Business/Organization Logo

Browse Files
Please upload a high resolution version of your business/organization's logo (transparent background preferable) Cancelof
Website*
http://www.website.org
Primary County of Operation*
Please select the county where you provide the majority of your services. If you serve the entire state, please select “Statewide”
If you operate in multiple counties, please select those counties:*

StatewideBarbourBerkeleyBooneBraxtonBrookeCabellCalhounClayDoddridgeFayetteGilmerGrantGreenbrierHampshireHancockHardyHarrisonJacksonJeffersonKanawhaLewisLincolnLoganMcDowellMarionMarshallMasonMercerMineralMingoMonongaliaMonroeMorganNicholasOhioPendletonPleasantsPocahontasPrestonPutnamRaleighRandolphRitchieRoaneSummersTaylorTuckerTylerUpshurWayneWebsterWetzelWirtWoodWyoming
Do you operate in a 2nd County? (Please select “No” if you answered “Statewide” to the previous question)

YesNo
2nd County of Operation
Please select a second county where you provide sevices
Do you operate in a 3rd County?

YesNo
3rd County of Operation
Please select a third county where you provide sevices
Do you operate in a 4th County?

YesNo
4th County of Operation
Please select a 4th county where you provide sevices
Do you operate in a 5th County?

YesNo
5th County of Operation
Please select a 5th county where you provide sevices
Do you operate in a 6th County?

YesNo
6th County of Operation
Please select a 5th county where you provide sevices
Do you operate in a 7th County?

YesNo
7th County of Operation
Please select a 5th county where you provide sevices
Do you operate in a 8th County?

YesNo
8th County of Operation
Please select a 5th county where you provide sevices
Primary Contact (Will not be shared)*

First NameLast Name
Position
Will not be shared. If none, please enter "N/A"
Primary Contact Email (Will not be shared)
example@example.com
Primary Contact Phone (Will not be shared)

Area CodePhone Number
Please enter your hours of operation using a Sunday to Saturday week*
Business Address (Physical Location)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
General Contact Name (Will appear on Resource Guide. If none, please enter "None")

First NameLast Name
General Email (Will appear on Resource Guide)
example@example.com (If none, please enter "None")
General Phone (Will appear on Resource Guide)

Area CodePhone Number
Mailing Address (If different from Physical Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Facebook Page
Instagram Profile
LinkedIn Page
Twitter Profile
YouTube Channel
Should be Empty: