• Plumas Information & Referral

    APPLICATION TO LIST OR REQUEST CHANGES

  • Thank you for taking the time to submit your organization’s information to our vital community database.


    • Information will be input from this form into the database. Please help us successfully guide community members to you by submitting a complete and accurate application.

    • Page 1, “AGENCY INFORMATION”: Please carefully include all applicable information about your organization, including a main Contact Person (and email address) for future updates, and your Agency’s Director, CEO, etc.

    • Page 2, “PROGRAM/SITE INFORMATION”: Please carefully include all applicable information about your program. Be sure to list all sites associated with each Program. (A program could include support group/service/class/reoccurring events etc.)

    • If your agency offers multiple programs/services, you can enter up to three different programs/site information.

     In some cases, multiple programs can be listed on one page such as: 1. Services are all related (various counseling services and support groups, health care services, etc.). 2. If no more than two phone numbers are needed to contact the various programs.

    • If you are requesting changes to a previous application please fill in agency/program name and any fields needing to be changed only.

    • Please complete the listing application as soon as possible to avoid delays. We look forward to including your valuable services for our community!

    If you have questions, please contact
    Nina Peay at 530-283-2735, ext 830
    or npeay@plumasruralservices.org

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  • Phone Numbers (Use "+" for additional numbers)

  • Contact person's information for future updates to this listing:

  • Person in charge (i.e. Owner, Director, General Manager, etc...):

  • I agree that all information provided on these forms may be made public via 2-1-1 Plumas’s database, online listings, and printed lists.

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  • APPLICATION TO LIST OR REQUEST CHANGES
    (If requesting changes to listing, please fill in Agency/Program name and any fields needing changes.)

    Up to three programs/services can be entered seperately on this form.

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  • Hours of Operation

  • Please enter the Contact information for future updates to this listing:

  • APPLICATION TO LIST OR REQUEST CHANGES
    (If requesting changes to listing, please fill in Agency/Program name and any fields needing changes.)

     

    Program #2

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  • Hours of Operation

  • Please enter theContact information for future updates to this listing:

  • APPLICATION TO LIST OR REQUEST CHANGES
    (If requesting changes to listing, please fill in Agency/Program name and any fields needing changes.)

     

    Program #3

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  • Hours of Operation

  • Please enter theContact information for future updates to this listing:

  • Use the "Back" button if you need to edit your information. If done, please click "Submit".

     

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