Help People Find Services and Benefits to Meet Their Basic Needs
www.washingtonconnection.org
You are invited to join Washington Connection, a web-based benefit portal where people can easily and securely learn about and apply for a broad array of services and benefits online: food, cash, and medical assistance; child care subsidies; long-term care services and support; and drug and alcohol treatment. For many other services that require different application processes, the website provides contact information and links to those service programs.
Being a partner, you will periodically receive updated information related to services or features that are supported by Washington Connection. You will have a local contact for your questions, and have the opportunity to attend community partnership meetings, network with other organizations, and provide feedback. You may also receive technical assistance and marketing materials as needed.
To join, simply fax or email the Community Partner Registration Form to your Regional Community Partnership Coordinator listed below. You will be contacted after your information is received. If you have any questions, contact Stephanie Hill at or (360) 725-4666. You may find more information about community partnerships at http://www.dshs.wa.gov/servicereform/communitypartner.shtml.
Region / Covered Areas / Regional Coordinator / Email / Phone / Fax1 / Between Chelan and Spokane Counties / Barb Mooney / / 509-227-2812 / 509-227-2822
Between Kittitas and Columbia Counties / Dennette Woodiwiss / / 509-225-7904 / 509-575-2904
2 / Between Whatcom and King Counties / Ty Ahlquist / / 206-272-2144 / 206-298-4443
3 / Between Pierce and Kitsap Counties / Vicky McLaurin / / 253-476-7032 / 253-593-2233
Between Clallam and Klickitat Counties / Patty Busse / / 360-565-2182 / 360-417-1461
Community Partner Registration Form
This registration form acknowledges the ability of the partner organization listed below to use Washington Connection as a tool to increase their customers’ access to services and benefits that help meet their basic needs.
COMMUNITY PARTNER ORGANIZATION / UBI or EIN/TIN / COUNTYREPRESENTATIVE NAME & TITLE (Printed) / PHONE NUMBER / EMAIL ADDRESS
MAILING ADDRESS: NUMBER STREET CITY ZIP CODE
PHYSICAL ADDRESS: NUMBER STREET CITY ZIP CODE
ORGANIZATION TYPE
College or School Community Organization Government Agency Library Medical Provider Tribe or Tribal Agency Other:
LEVEL OF CUSTOMER ACCESS THE PARTNER ORGANIZATION CAN PROVIDE
Public (available for general public and new customers) Limited (available for agency clients/customers only)
SERVICE LEVEL OF SUPPORT THE PARTNER ORGANIZATION CAN PROVIDE (You may choose to offer assistance at both service levels)
Level 1: Host Organization (Check all that apply)
Display posters and printed marketing materials about Washington Connection
Provide applicants with access to a computer with an icon to Washington Connection on the desktop
Provide applicants with assistance in answering questions about Washington Connection website
Level 2: Assisting Agency - Provides applicants with assistance in completing and submitting online application
(To protect the confidentiality of client information, Assisting Agencies will be required to fill out Data Share Agreement and Non-Disclosure Form. Contact your Regional Coordinator for more information.)
TECHNICAL ASSISTANCE NEEDED (Orientation, training, marketing materials, icon setup, etc.)
COMMUNITY PARTNER REPRESENTATIVE SIGNATURE (or e-SIGNATURE) / DATE