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Note: Click here for webinars on 2-1-1.

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Date
Organization Name
Contact Individual's Name*
First Last
Contact's Phone*
Contact's Email*
Organization Address
Street Address Address Line 2 City State ZIP Code

Request Details
- In-Person Presentation
- Information Booth/Table
- Materials
- Webinar
Date(s) of Event
Date(s) Flexible
- Yes
- No
Time(s) of Event
Time(s) Flexible?
- Yes
- No
Name/Type of Event
Event Location
Organization/Company (include Street Address, City, State and Zipcode)
Audience
Participant Estimate*
Please choose from the following topics to help us determine what type of presentation you are looking for:
- Homeless Shelter Intake/Coordinated Access Network (CAN) Process
- CDI/Birth to Three Services
- Child Care/Care for Kids
- General 2-1-1 Overview
- Demo of 2-1-1 Website (webinars available)
- Demo of 2-1-1 Counts (webinars available)
- EMPS/Suicide
Additional Information/Comments
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211 is a program of United Way of Connecticut and is supported by the State of Connecticut and Connecticut United Ways.