Children and Youth Programs and Services Community Inventory Person Completing the Form Contact Information Program Name Program Description Briefly describe the program. Program Category Early Learning Outdoor Adventures Health & Fitness Fun & Education The Arts Cultural & Community Engagement Please select the appropriate category or categories associated with your program. Services Provided Type of Services Provided Direct Contract Other Identify the type of service provided. Time and Season Services Provided Before school After school Summer Spring break Internship Mentorship Please select all that apply Income Requirement Yes No Is there an income requirement to participate? Other Eligibility Requirements Briefly describe additional eligibility requirements Number of Children/Youth Served Ages of Children/Youth Served Birth to three Three to five Elementary school age Middle school age High school age Post-secondary Please select the ages of children/youth served: Primary Zip Code Served Location of Services Waiting List Yes No Is there a waiting list? Length of Waiting List Opportunity for Expansion Yes No Is there opportunity for expansion? Captcha Submit
