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Shelby County Division of Community Services Event Participation Request Form
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Interested in having the Shelby County Division of Community Services participate in your community/health fair or send someone to speak at your event? Please complete the form to request our participation. Thank you!
Name of the Program/Event
Organization Sponsoring the Event
Type of Event
Community Group Meeting
Class or Professional Presentation
Name of Location
Date of the Event
Date of the Event
Time of the Event
Time of the Event Start Time
Time of the Event End Time
Contact Person's Name
Check the department(s) below for participation in your event
The Aging Commission
The Community Services Agency
The Office of Justice Initiatives
The Shelby County Crime Victims Center/Raper Crisis Center
Behavioral Health Unit of the Office of Justice Initiatives
The Division of Community Services (representative of all departments listed above)
Items Provided by the Sponsor
Table and chairs
Canopy or Tent
I would like to have someone speak at this event.
Length of time for speaker
Length of time for speaker Start Time
Length of time for speaker End Time
I would like for them to speak about:
I have some questions about the services offered by the Division of Community Services. Please connect me with information about:
Assistance with finding services for a senior citizen.
Emergency help with rent, mortgage or utilities.
Special courts for persons with persistent mental health problems, A&D issues or for veterans.
Help for persons who are incarcerated or awaiting a criminal trial.
Services for victims of crime including counseling, court support and concrete social service needs.
Rights, services, or programs for veterans.
Specific needs of Spanish speakers in our community.
Would you like to be added to our email list to receive our monthly newsletter, Community Connections?
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