Add/Update Info / Delaware Helpline

Add/Update Info

Use this form to submit your program or to update the information we have about your program. We do request that you complete the form in its entirety.

If you wish to add a new program to our database, please complete as much of this form as possible. The more information we have, the more useful it is to those we serve.

For your records, please print this page before you send it.

Basic Information

What is the name of your agency or organization?

What is the name of your program?

If your program goes by another name, please enter it here:

What is the mailing address?

Contact Information

We encourage listing a primary contact's name:

Do you have a website you'd like to list?

Is there an e-mail address for people to use?

What is the main phone number to call?

Is there an alternate phone number?

Would you like to list a fax number?

Program Information

Please provide a description of your program:

What areas does the program serve?

(e.g. New Castle County, Wilmington Zip Codes 19801 thru 19806, etc...)

What days/hours is this program available on?

(e.g. Monday, Wednesday and Friday, 6am to 4:30pm)

Please enter any fees associated with the program:

(e.g. Medicare based, $100, etc...)

What is the intake process?

(e.g. Referral by hospital, By appointment only, etc...)

Who is eligible for the program?

Does the program accommodates languges other than English?

Please provide any key words that might describe your program:

(e.g. food closet, immunizations, etc...)

Information for Delaware Helpline

Please provide the name and phone number of a contact in case we need additional information. This will not be listed on our website.

Contact's name:

Contact's phone number: