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There are 2 parts to this application. For your first service, complete both the Agency Profile and the Service Profile. For each additional service or program you provide, fill in the Agency Name and complete a Service Profile.
Complete any information in this box that is different from the contact information in the Agency Profile
(Complete all options that apply)
Creating and offering accessible and usable environments benefits everyone. This short set of questions will help older adults and people with disabilities better access your program or service.
(Answer only if service is provided to the consumer on-site)
I understand and agree that:
The agency/service information I have provided will be included in the VirginiaNavigator database and accessible to the public at www.mylifemycommunityvirginia.org, www.VirginiaNavigator.org, www.SeniorNavigator.org, www.disAbilityNavigator.org, www.VeteransNavigator.org or additional sites as they are developed. The information is original, complete and correct. It is not pornographic, obscene, defamatory or libelous. VirginiaNavigator reserves the right to 1) edit information for brevity, clarity and content, 2) publish the information in a variety of media, subject to confidentiality issues, and 3) remove any submission, if they believe that information may create a liability.
(If you are a Developmental Disability Service Provider, please complete the fields below.)