Agency Inclusion Forms listed by VT 2-1-1 Region

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Please take time to read the Vermont 211 Database Inclusion/Exclusion Policy before submitting forms.  This policy was established by the Vermont 2-1-1 Collaborative in accordance with the Alliance of Information & Referral Systems (AIRS) Standards for Professional Information and Referral Services , Section II, Standard 5.

Form Instructions

The Agency Profile Form asks specifically for information about your agency's main office.  Please complete a separate Program Information Form (with specific information about services, eligibility, hours, documents needed, etc.) and a separate Branch Office Information Form (if your agency has outreach or satellite offices).

*When submitting forms, please send them to the Regional Resource Specialist  assigned to your area (also listed on the forms) to ensure the forms are properly received and processed.


Forms listed by VT 2-1-1 Region

Northwest Vermont Region - Carmel Quinn, Resource Manager.
Chittenden, Lamoille, Franklin, Grand Isle, and  Washington Counties.

  1. Agency Profile Form

  2. Program Information Form

  3. Branch Information Form

Northeast Vermont Region - Dixie Burns, Regional Resource Specialist.
Orleans, Essex, Caledonia Counties and certain towns in Orange County:
Topsham, Newbury, Williamstown, Washington, Corinth, and Newbury.

  1. Agency Profile Form

  2. Program Information Form

  3. Branch Information Form

 Southeast Vermont Region - Jim Tonkovich, Regional Resource Specialist.
Windham, Windsor, and Orange Counties.

  1. Agency Profile Form

  2. Program Information Form

  3. Branch Information Form

 Southwest Vermont Region - Beth Diamond, Regional Resource Specialist.
Addison, Bennington and Rutland Counties.

  1. Agency Profile Form

  2. Program Information Form

  3. Branch Information Form