If you are an organization or group dedicated to helping people experiencing or at risk of homelessness in Pinellas County, please complete this form so that your program's information can be included in the virtual Pinellas Homeless Resource Guide. Please note that requests are not guaranteed.
Organization Information
Information about the organization and individual submitting Pinellas Resource Guide information
1) Organization *
2) Name *
Title
First Name
Last Name
Suffix
3) Phone *  
4) Email *  
5) Are you a Continuum of Care (CoC) member? *  
Status of Resource Guide Entries
Please indicate if current program information is accurate, requires updates, or should be removed, or if new programs should be included.
6) Do any entries require updating? *  






7) Program(s) to be Removed from Resource Guide
Please provide information about the program(s) you would like removed from the Pinellas Homeless Resource Guide.
New or Updated Program Information
Requests to update or add program information can be completed by 1) entering program information into the box in question # 8, OR 2) answering survey questions 9-15b. Please note that providers may CHOOSE EITHER METHOD and do not need to complete questions 8 and 9-15b.
Option 1: Written Entries
Please include separate entries for each program in bullet point format: Organization / Program Name; Phone Number(s); Website; Address(es); Hours; Eligible Recipients (everyone, specific zip codes / populations, etc.); Documentation Requirements (ID, bill, paystub, etc.); Program Description; Additional Information.
8) New or Updated Program Information  
Option 2: Update Via Survey
If you prefer, program information can be added or updated by answering questions 9-15b below, which provide prompts about populations served, available services, etc. Please note that if updating multiple entries via survey, multiple forms must be completed. Please also note that this section is not required if information was provided in the text box above.
9) Program Name  
10) Program Phone Number
11) Program Website
12) Program Address(es)  
13) Program Hours of Operation / Schedule  
14) Populations Served by Program  













14a) Other Populations Served by Program
15) Services Offered by Program  































15a) Other Services Offered by Program
Additional Information
16) Additional Information, Comments, or Requests  
Supporting Documentation and / or Questions
To ask questions or share supporting documents, such as program flyers, please email Info@HLAPinellas.org.

To ask questions or share supporting documents, such as program flyers, please email Info@HLAPinellas.org.

Visit the HLA online: www.PinellasHomeless.org
View the Homeless Resource Guide: www.PinellasHomeless.org/resourceguide
Become a Member of the Pinellas Continuum of Care (CoC): www.PinellasCoC.org/join