Homeless & ReEntry Helpers Web Site - Our Helpers Sign-Up Form

Homeless & ReEntry Helpers, Inc.
918 E. Michigan St., Indianapolis, IN 46202 USA - View Map to HRH
(317) 547-0500 | 317-547-0700 Fax | Helpers@HRHcompanies.com

Our Helpers Sign-Up Form - Notes & Instructions
To register with HRH, please complete this form and submit it to HRH for approval.
PLEASE READ: This page is equivalent to a "Yellow Pages" ad for your organization. It is your
responsibility to tell your story on why people should call your organization and/or use your services.
When selecting your "Categories" and "Topics", please select only those categories and topics that your organization
offers to your clients. Please do not check categories and topics that your organization is not directly responsible for.

Information Added by HRH (Fields in Yellow are Required)
Name of Organization / Helper			ID #: To be assigned
Acronym or 2nd Name
Address
City
State
Zip
Main Office Phone \| Fax
Main Email Address
Web Site Address
Information Added by the Organization (Helper / Provider)
Primary Services Provided
Secondary Services Provided
Eligibility \| Requirements
Procedures \| Fees
1st Contact's Name \| Title
1st Contact's Main Phone \| Fax
1st Contact's Cell \| Home
1st Contact's Email Address
2nd Contact's Name \| Title
2nd Contact's Main Phone \| Fax
2nd Contact's Cell \| Home
2nd Contact's Email Address
3rd Contact's Name \| Title
3rd Contact's Main Phone \| Fax
3rd Contact's Cell \| Home
3rd Contact's Email Address
Days \| Hours of Operation
Languages
Bus Route(s)
Volunteers Needed
Supplies & Items Needed
What We Have Available Now
Additional Information

Form #30 (Revised 2Sep09 at 1505 by DEH)