Utah Go Local Form

Utah Go Local Form

Use this form to submit human services organization data for entry into Utah's Go Local System.
Please email the Utah Go Local Staff if you have questions about this form.

Please provide your contact information:

Name:

Where You Work:

Work Phone (with area code):

Work Fax:

Your Email:

Please provide the following information about the human services organization you are submitting
(This is the information that will be published in Go Local)

Organization Name:
Parent Organization Name (optional):
Address Line 1:
Address Line 2 (optional):
City:
State:
Zip Code:
Phone (with area code):
Email (optional):
Website Address (if available):
State-wide Resource? Yes No
Organization Description:
Comments: (for Utah Go Local Staff)
Date information was gathered