2-1-1 Santa Clara County
CADRE – City of San Jose Flooding
Please complete multiple forms if you are offering more than one service. If you complete multiple forms, you only need to complete the details for Agency General Information on one form, but please include your agency’s name on every form.
AGENCY GENERAL INFORMATION
Agency Name:Click here to enter text.
Address: Click here to enter text.
City: Click here to enter text.State: Click here to enter text.Zip Code:Click here to enter text.
Website: Click here to enter text.
Agency Main Phone: Click here to enter text. Main Agency Email: Click here to enter text.
SAN JOSE FLOOD SERVICES
Service Name:Click here to enter text.
Description of service offered:Click here to enter text.
Who is eligible to receive service: Click here to enter text.
Days/Hours:Click here to enter text.
How to access service (appointment/walk-in/etc.):Click here to enter text.
Cost of service: Click here to enter text.
Documents/Information required to access service: Click here to enter text.
What language(s) is/are this service offered in: Click here to enter text.
Any other special information that should be known about this service:
Click here to enter text.
Service Contact Information (if different from the agency’s main #)
Phone:Click here to enter text. Email: Click here to enter text.
Website (if specific to the program not the agency’s main website)
Additional Location(s) of Service
Please include site name, address, and phone number
- Click here to enter text.
VOLUNTEER OPPORTUNITIES
Volunteer Project Description:
Contact Name:Click here to enter text.
Contact Phone:Click here to enter text.
Contact Email:Click here to enter text.
DONATIONS
Contact Name:Click here to enter text.
Contact Phone:Click here to enter text.
Contact Email:Click here to enter text.
What is needed?
Click here to enter text.
Additional information you would like to add:
Click here to enter text.
Please email your completed form(s) and or questions to or feel free to contact us at (408) 345-4380.
**To update your information after your form is submitted, please send an email to with the subject line – SAN JOSE FLOOD UPDATE
UNITED WAY BAY AREA | 1400 PARKMOOR AVENUE | SAN JOSE CA 95126 | (408) 345-4300