PROJECT HOMELESS CONNECT—SPRINGFIELD 2009 Vendor Application Project Homeless Connect will take place September 29, 2009, 8 am to 2 pm at the MassMutual Center. Project Homeless Connect is a one-day event designed to link persons at risk or experiencing homelessness with services, benefits and housing. To participate as a vendor, please submit this form, by the deadline: September 1, 2009. Return the form to Gerry McCafferty, gmccafferty@springfieldcityhall.com, fax 787-6515 AND to your team captain. Team captains are listed on the following page. ORGANIZATION INFORMATION Name: ____________________________________________________________________________ Address: __________________________________________________________________________ Phone: ___________________________________________________________________________ Primary contact for PHC: ____________________________________________________________ Email: ____________________________________________________________________________ PROJECT HOMELESS CONNECT SERVICES What ACTION POINT will you offer at Project Homeless Connect on September 29? __________________________________________________________________________________ __________________________________________________________________________________ PROJECT HOMELESS CONNECT NEEDS Typical vendor spaces are 10’x10’ square, with one 8’ long table and two chairs. Some vendors need more chairs, or a smaller table. What are your needs for space/table? (If you have specific needs that will not fit in this space—for example, for space for medical services, please describe on the back.) __________________________________________________________________________________ __________________________________________________________________________________ What else will you need to do your work? (e.g., phone, internet, electricity, plumbing, copy machine)? Will you need privacy curtains (on all 4 sides, or 3?) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Set up for Project Homeless Connect will take place on Monday, Sept. 28, 3-5 pm. On the day of Project Homeless Connect, vendors should have booths fully set up and staffed before 8 am—there is often an early morning rush for services. PROJECT HOMELESS CONNECT—SPRINGFIELD 2009 Vendor Application Please send a second copy of this form to your Team Captain. Team Captains will be the ones working with you to design your team area within the MassMutual Center. Team Captains can also answer any questions. Team Captains: Health Care Judy Mealey, 748-9064, judith.mealey@sphs.com, fax: 748-9049 Geraldine Kennedy, 748-9064, geraldine.kennedy@sphs.com, fax: 748-9049 Behavioral Health Molly Bresnahan, 748-9064, mollie.bresnahan@sphs.com Birth Certificates and Identification Vickie Riddle, 452-0606, v.riddle@diospringfield.org; fax: 452-0647 Income/Public Benefits Clare Deucher, (617) 654-7458, clare.deucher@ssa.gov, fax: (617) 654-7432 Housing Lauren Voyer, 233-1666, lvoyer@haphousing.org, fax: 731-8723 Dave Havens, 734-5376, dhavens@mhainc.org, fax: 737-7949 Employment Richard Berrena, 858-2885, rberrena@futureworks-now.com, fax: 858-2810 Family Kim Lee, 732-5183, klee@startatsquareone.org, fax: 739-0310 Veterans Steve Como, 413-584-4040 x 2288, scomo@unitedveterans.org, fax: 413-582-3075