Suggest a service | 907-373-2628

Please take some time to complete the below selections to be updated into Connect-Matsu’s database. This is the current general format of the searchable options within our database. If multiple locations are present, please fill out a form for each. Just a courteous reminder, this information will be populated into our database which in time will be searchable for the community. If you have any questions or need assistance in completing this form, please feel free to reach out to our office at 907-373-CNCT (2628) for assistance.

"*" indicates required fields

Type of Update*

Organizational Name*

Type of Organization*

Please select the field that represents your organization the best.

Phone Number*

Please put the number you wish to be reached by community members.

Point of Contact

Please provide the name of an individual in your organization that we may reach out to in regards to this listing.

Email Address*

Website URL

Physical Address*

Street Address Address Line 2 City State ZIP Code

Borough/ Area Served*

Hours of Operation*

Funding Source

Do you have funding used to support community members in need? By sharing your funding sources with us it helps to streamline referrals to your services. Please enter how your organization is funded, i.e. grants, federal, state...

Ages Served*

Translation Services Offered*

Languages Offered to Clients

Please list any additional languages your organization has the ability to engage clients in.

Telehealth Offered

Accessibility*

Handicap Accessible

Visual Assistance

Auditory Assistance

Other

Unable to Accommodate

Eligibility Requirements*

Tribal Affiliation Required

Referral Needed

Wait List

Average Wait

Required Documents for Service

What documents are required for services (application, id, pay-stub, etc...)

Insurances Accepted

Please list insurances accepted (medicare, medicaid, private, no insurance needed, etc...)

Intake Process

Organizational Summary*

Services Provided*

Untitled

Name Of Person Making Request*

First Last

Email of Person Making Request*

Phone Number of Person Making Request*

This is to ensure we may be able to reach you with additional questions if needed.

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