Homeless & ReEntry Helpers, Inc.
916 E Michigan St, Indianapolis, IN 46202 - Map to HRH & HHOOT
(317) 635-0500 Voice | (317) 631-0500 Fax | Helpers@HHOOT.com

Our Helpers Sign-Up Form - Notes & Instructions
To register with HRH, please complete this form and submit it to HRH for approval.
PLEASE READ: This page is equivalent to a "Yellow Pages" ad for your organization.  It is your
responsibility to tell your story on why people should call your organization and/or use your services.
When selecting your "Categories" and "Topics", please select only those categories and topics that your organization
offers to your clients.  Please do not check categories and topics that your organization is not directly responsible for.

Information Added by HRH (Fields in Yellow are Required)

Name of Organization

ID #: To be assigned

Acronym or 2nd Name

 

Address

 

City

State

Zip

Main Office Phone | Fax

Main Email Address

Web Site Address

Information Added by the Organization (Service Provider)

Primary Services Provided
Secondary Services Provided

Eligibility | Requirements

Procedures | Fees

What We Have Available Now

Days | Hours of Operation

Languages
Bus Route(s)

Volunteers Needed

Supplies & Items Needed

Additional Information

1st Contact's Name | Title
1st Contact's Main Phone | Fax
1st Contact's Cell | Home

1st Contact's Email Address

2nd Contact's Name | Title
2nd Contact's Main Phone | Fax
2nd Contact's Cell | Home

2nd Contact's Email Address

3rd Contact's Name | Title
3rd Contact's Main Phone | Fax
3rd Contact's Cell | Home

3rd Contact's Email Address

 

Form #30 (Revised 4May10 at 1700 by DEH)

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Copyright (c) 2007-2010 by Homeless & ReEntry Helpers, Inc., P.O. Box 1724, Indianapolis, IN 46206 USA | 317-547-0500 Voice
For suggestions or questions regarding this Web site please contact Don Hawkins at: Hawkins@callHRH.com or 317-547-0700 Fax
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