27 September 2018
Dear Community Service Providers,
Community Resource Network (CRN) is currently updating the Hills Agency Contact List. CRN publishes and distributes this poster free of charge to community organisations, government agencies and community members in The Hills and surrounding local government areas.
Whether or not your agency has been on the list before, if you would like to appear on the 2015 Hills Agency Contact List, CRN requires your agency name and phone details, along with your formal consent to print and distribute this information.
The information update and consent form is printed on the following page.
Due to the limitation of space on the poster, please select only one category that best suits your service type or target group.
We cannot guarantee that every agency will be published, although we make every effort to include as many as we can.
Only the agency name and phone number will appear on the list. All other information will be included in our own organisational database for our records.
It is important that the signed consent form be returned by fax, email, or post to CRN no later than 2ndof March 2015. If the signed form is not returned by this date, your agency’s contact details maynot be included.
Please send the form to:
Email:
Fax:(02) 9832 4802
Post:PO Box 149, Plumpton NSW 2761
In order to help us improve our service to you and to the community, please assist us by also answering the feedback questions that are included in the form.
Thank you,
Anthony Brown
Project Officer (Communications)
Hills Agency Contact List 2015 – CONSENT FORMName of Agency/Service:
Phone Number:
Type of Service or Target Group (please tick one only)
Aboriginal Services / Disability Services / Legal Services
Accommodation Services / Drug & Alcohol Support / LGBTIQ Services
Aged Care Services / Education & Training / Mental Health
Home and Community Care / Employment Services / Regional Resource Groups
CALD Services / Family Support Services / Service Clubs
Children’s Services / Govt Dept. (State/Fed) / Transport
Community/N’hood Centres / Health Services / Youth Services
Counselling Services / Helplines / Useful Numbers & Websites
Physical Address:
Postal Address:
Fax:
Email:
Website:
- How often do you use the HACL? (please tick one)
Frequently Occasionally Never
- What do you use the HACL for? (please tick one or more, as appropriate)
To refer clients
To find out more about another service or make general inquiries
To advocate for clients
To establish contact/network with other services
Other
- When you use the HACL how often do you get the results you want? (please tick one)
Often Sometimes Never
- Please indicate the number of HACL copies you wish to receive.
A3 Size
I agree for the contact details of the above agency/service name and phone number to be added to the HillsAgency Contact List 2015.
Contact Name: / Position:Signature: / Date:
PLEASE SIGN AND DATE THE FORM BEFORE RETURNING TO CRN BY 02/03/2015
FAX: (02) 9832-4802 | POST: PO Box 149 Plumpton NSW 2761 | EMAIL:
58 Armitage Drive Glendenning | PO Box 149 Plumpton NSW 2761
P: 02 9832 4762 | F: 02 9832 4802 | E: | W: crn.org.au