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Dear Agency Director:

Pocono Alliance maintains information on health and human services that serve Monroe County, the state of Pennsylvania, and national organizations. This information is then provided to callers who contact us through PoconoInfo. PoconoInfo is a free service of the Pocono Alliance and there is no charge to be listed on the database. Please review your posting on our websiteto make sure the information is accurate. Our website address is: Any edits or changes please indicate on the provided form and return.If you need assistance, please contact me. We are an excellent referral source for your agency!

Please complete the following information and return by fax to 570-234-3469or email .

Agency Name: ______

  1. Has your general information changed? (i.e., address, phone, fax, email, website address, TDD phone, other phone, hotline phone, etc.)

______Yes______No

If your answer is yes please provide the changes below:

______

  1. Has your description of your services and programs changed?

______Yes_____ No

If your answer is yes please provide the changes below:

______

3. Have your hours of operation changed?_____ Yes_____ No

If your answer is yes please provide the changes below:

______

______

4. Has the territory that you cover changed? (i.e., MonroeCounty, CarbonCounty,

Pennsylvania, United States of America, etc.) _____ Yes_____ No

If your answer is yes please provide the changes below: ______

______

  1. Has your intake procedure or intake requirements changed?

_____ Yes_____ No

If your answer is yes please provide the changes below: ______

______

  1. Has your eligibility changed? (i.e., MonroeCounty residents only, alcohol

and/or other drug use involvement, none, residents of Tobyhanna and Tunkhannock Townships or Person with Library Card that has Access PA Sticker, anyone needing clothing, etc.) _____ Yes _____ No

If your answer is yes please provide the changes below: ______

______

  1. Has your facility access (wheelchair accessible) changed?

_____ Yes_____ No

If your answer is yes please provide the changes below: ______

______

8. Has your director’s information and/or contact information changed?

_____ Yes______No

If your answer is yes please provide the changes below: ______

______

9. Has your languages spoken changed? _____ Yes_____ No

If your answer is yes please provide the changes below: ______

______

______

  1. Have your fees, type of fees, fee amounts, and insurance accepted changed?

_____ Yes_____ No

If your answer is yes please provide the changes below: ______

______
______
______

  1. Has your intended participants, target group, and age group changed?

(i.e., all individuals, children, adolescents, consumers, all ages, all adults, all youth, birth to 1 yrs, 60 & older, etc.)

_____ Yes _____ No

If your answer is yes please provide the changes below: ______

______
______
______

Thank you for your help in updating this resource. If you have questions regarding the purpose of this questionnaire, please contact PoconoInfo at 570-517-3954.

Sincerely,

Maria Schramm

PoconoInfo, Information & Referral Manager

Maria Schramm:

PoconoInfo: (570) 517- 3954

Fax: (570) 234-3469