Closing Early: Thursday, May 14 at 4:30 pm

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Open Tuesday–Sunday: 10:00am to 5:00pm

Community Access Program

Community Access Program Registration

Please complete the form below to register your organization for our Community Access Program. Note: Completing this form does not guarantee enrollment.

Organization Information

Name of Organization(Required)

Program Name

If you are a program of a larger organization, please indicate that here.

Which best describes your organization/program?(Required)

Government Agency

Human Service Agency

Social Service Agency

Nonprofit Organization

Educational Institution

Childcare Facility

Public Health Organization

Check all that apply.

Organization's Nonprofit Tax ID or EIN Number

To qualify for a Community Partner Membership, you must be a 501(c)3 or government agency.

Communities Served(Required)

Indigenous communities and individuals

Other BIPOC communities

Refugees and immigrants

At-risk LGBTQ identified youth

Unhoused and low-income individuals

Formerly incarcerated individuals and their families

Disabled and neurodiverse individuals

Low-income youth

Other

Check all that apply

Ages Served(Required)

Youth

Adults

Check all that apply

If "other" selected, please describe:

Address(Required)

Note, organizations must be located in Tompkins, Cortland, Cayuga, Seneca, Schuyler, Chemung, or Tioga counties

City(Required)

State(Required)

Zipcode(Required)

Website

Contact Information

Contact Name(Required)

Contact Title(Required)

Contact Email(Required)

Contact Phone(Required)

ID Information

Describe the ID or Badge that your staff will use as an identifier.(Required)

Please be specific. Include the name of organization, department, and/or program as it appears on the identification. This is what our front desk staff will use to identify your organization/program when checking in. Examples: 1) City of Ithaca ID and name of staff person; 2) City of Ithaca, Office of Family Services and name of staff person.

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Access

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Resources!

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