West Virginia Statewide Resource Guide

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

Case Management Clinical Clothing Assistance Community-Based Organization (CBO) Disease Vaccination/Testing/Treatment Services (e.g. - HIV, Viral Hepatitis) Financial Assistance Services For-Profit Free Clinic Group Practice Hard Reduction Program Hospital Housing Opportunities for People With AIDS (HOPWA) Housing Services (e.g. - Rent/Mortgage Assistance, Temporary/Permanent Housing, Shelter) Job Placement/Career Services Legal Services Linkage to Care Local/County Health Department Mobile Clinic Non-Clinical Nonprofit Nutritional Services (e.g. - SNAP, Food Pantry/Bank) Private Practice Referral Services Ryan White Sexually Transmitted Disease/Infection Testing/Treatment (STD/STI) Telehealth/Telemedicine Translation Services Transportation Services Urgent Care
Resource Type *

HIV Substance/Opioid Use Disorder (SUD/OUD) Viral Hepatitis Other
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) Cancel of
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: *

Statewide Barbour Berkeley Boone Braxton Brooke Cabell Calhoun Clay Doddridge Fayette Gilmer Grant Greenbrier Hampshire Hancock Hardy Harrison Jackson Jefferson Kanawha Lewis Lincoln Logan McDowell Marion Marshall Mason Mercer Mineral Mingo Monongalia Monroe Morgan Nicholas Ohio Pendleton Pleasants Pocahontas Preston Putnam Raleigh Randolph Ritchie Roane Summers Taylor Tucker Tyler Upshur Wayne Webster Wetzel Wirt Wood Wyoming
Do you operate in a 2nd County? (Please select “No” if you answered “Statewide” to the previous question)

Yes No
2nd County of Operation
Please select a second county where you provide sevices
Do you operate in a 3rd County?

Yes No
3rd County of Operation
Please select a third county where you provide sevices
Do you operate in a 4th County?

Yes No
4th County of Operation
Please select a 4th county where you provide sevices
Do you operate in a 5th County?

Yes No
5th County of Operation
Please select a 5th county where you provide sevices
Do you operate in a 6th County?

Yes No
6th County of Operation
Please select a 5th county where you provide sevices
Do you operate in a 7th County?

Yes No
7th County of Operation
Please select a 5th county where you provide sevices
Do you operate in a 8th County?

Yes No
8th County of Operation
Please select a 5th county where you provide sevices
Primary Contact (Will not be shared) *

First Name Last 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 Code Phone Number
Please enter your hours of operation using a Sunday to Saturday week *
Business Address (Physical Location)

Street Address

Street Address Line 2

City State / Province

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

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

Area Code Phone Number
Mailing Address (If different from Physical Address)

Street Address

Street Address Line 2

City State / Province

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