About Us
  Search for Services
  Are You A Provider?
 
~  Change of Information
~  Inclusion Criteria
~  New Agency / Program Information
~  Volunteer Opportunity
  CareGiver Support
  Bulletin Board
  Contact Us
  Links
  News
  Site Map
  Home
Just 1 Call Just 1 Call Print This Page 

View in Spanish

    
Inclusion Criteria Form

Instructions:

1 - Please check the box to the left of the one category that describes your program

and

2 - Check all boxes under that category that apply to your program.

A. Incorporated as a non-profit (IRS 501(c) 3 status) providing direct health and human services, and meeting all of the following criteria:

Please check all items below that apply to your program.
Has an established address, phone and available contact person.
Has been providing services for one year.
- OR -
Is a member of the Better Business Bureau.

B.An incorporated non-profit providing indirect services in one or more of the following areas:

Please check all items below that apply to your program.
Community organization and planning, improvement of standards and services, research and interpretation.
Financial support for health and human service agencies.
Governmental or civic licensing or endorsing of health and human service organizations.
Education and training for social work and related fields.
C. Government Agency
D. A for-profit organization may be included if it meets all of the following criteria:

Provides a specialized service for senior citizens or disabled individuals that enable these individuals to accomplish "Activities of Daily Living", as defined by the North Carolina Medical Assistance Program to include hygiene/bathing/ grooming, dressing, ambulating/mobility/transferring and eating.
Has an established address, phone and available contact person.
Is licensed/accredited, or a Medicare/Medicaid approved provider where applicable.
Has been providing services for one year.
- OR -
Is a member of the Better Business Bureau.


I certify that the information provided is true and accurate to the best of my knowledge. I understand that Just1Call does not guarantee inclusion in its health and human services database and listing of agencies and programs is based on established inclusion criteria. I understand that this information may be provided to individuals and published in a variety of formats, and that listing or publication of information does not guarantee referrals for services. I also agree to inform Just1Call of any agency or program changes or discrepancies.

Agency Name:
Director:
Title:
Telephone Number:
Date:
 

View in Spanish

Copyright © 2006, Just1Call