Weld Project Connect SERVICE PROVIDER REGISTRATION Organization(Required)Deliverable/Service provided(Required)Primary Contact(Required) First Last Day/Office Phone(Required)Cell Phone(Required)Email(Required) Provide a single, one-line question (based on Arial 9 pt. type) for the Guest Intake Form. Example: Are you over 18, born in Colorado and need to order your birth certificate?Intake Form QuestionA RESOURCE NOTEBOOK WILL BE AVAILABLE TO NAVIGATORS AND GUESTS TO LEARN MORE ABOUT EACH SERVICE. Write a paragraph describing specifically what your deliverable service is. Include any special requirements (age, children in the house, pregnant, etc.) that are conditions of your service. If your service represents a program, please explain that program and exactly what you will be doing at Weld Project Connect.Paragraph Description for Resource NotebookIt is important for us to understand the value of your service to the community. Everything, even a free service has a value. List what would be a fair value if a person had to pay for the service you provide. For example: 1 Haircut = $20.Value of ServiceLogistical NeedsSquare footage (amount of space) needed:Attach a detailed diagram showing desired layout. (Indicate table placement, chair placement, etc.)Max. file size: 300 MB. Electricity Yes No If YES you will need to provide a surge protector and a minimum of 50’ ext cordTables Yes No Table QuantityChairs Yes No Chair QuantityPrivacy Yes No Curtains Yes No Confidential Room Yes No Do you have an outdoor, mobile unit Yes No Please describe unitHow much space is neededElectricity Needed? Yes No Do you need tables and chairs for your area? Yes No # of tables# of chairsT-ShirtsTotal number of service providers/staff working the day of the event = Total # of T-shirtsSmallMediumLargeXLXXLXXXLOther (Please specify)ConnectivityIf bringing computer equipment, which devices need to connect to the Internet? Please check all that apply:Weld County Government services/departmentDevice #1 Desktop Computer Laptop Printer Device #2 Desktop Computer Laptop Printer Device #3 Desktop Computer Laptop Printer Device #4 Desktop Computer Laptop Printer City of Greeley service/departmentDevice #1 Desktop Computer Laptop Printer Device #2 Desktop Computer Laptop Printer Device #3 Desktop Computer Laptop Printer Device #4 Desktop Computer Laptop Printer Public/outside agency (Equipment you will be bringing)Needs (please mark all that apply) Wi-FI Bringing Printer Will need assistance with IT Device #1 Desktop Computer Laptop Printer Device #2 Desktop Computer Laptop Printer Device #3 Desktop Computer Laptop Printer Device #4 Desktop Computer Laptop Printer Special Needs: Δ
