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SNAP Community Partners

Organization Name

Contact Name

Contact Phone Number

Contact Email Address

Organization Street Address

Organization City

Organization Zip Code

Parish

Type of Organization Non-Profit
Faith Based
Governmental
Business
Other

Do you serve people outside your Parish? Yes
No

Do you currently serve the public or just a select client base? Public
Select Client Base

Level of LDH support you are interested in providing: (Silver and Gold levels require a computer with Internet access available to clients.) Gold (Provides assistive service)
Silver (limited assistance)
Bronze (Self-Service site)

What are your hours of operation?

Do you have Internet access where you plan to serve clients? Yes
No

Briefly describe your organization's mission and what services you currently provide to clients.

What equipment is currently available for client use? Computer
Phone
Fax Machine
Copy Machine
Computer Printer
Other
Check all that apply

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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