Here's where you add information about the assistance and resources you are able to offer during the pandemic conditions. Task Force AffiliationThe following information will help us identify the primary geographic area that you will be serving within. You can still submit an application if you do not currently have a formal affiliation with a task force. Primary Task Force - None -South Florida Human Trafficking Task ForcePalm Beach Human Trafficking CoalitionBroward Human Trafficking CoalitionNorthwest Florida Human Trafficking Task Force Here's where you can select the individual that referred you to this site. This is the individual that will be reviewing your submission. - Select a Coordinator (if any) -Laura Cusack :: Place of Hope at the Leighan and David Rinker CampusCaridad Mas-Batchelor :: International Rescue Committee / FloridaNicole Phillips :: Lavished MinistriesJumorrow Terra Johnson :: Office of the State Attorney, 17th Judicial Circuit Committee Member Outreach, Training and Education Committee Inter-Faith Committee Service Provider Law Enforcement Individual Contact InformationYour information will only be view-able by task force members and will not be distributed publicly. First Name Last Name Phone Number Email * Organization Info Organization Name Street Address Please no PO Boxes. City State/Province Zip Code Phone Number Organization Email There are two sections to list resources: The COVID19 Emergency Resources is to include emergency services that you are able to provider during the pandemic. The Post Pandemic Resources section is for resources you expect to have in place once current conditions improve. COVID19 Resources Help offered Any Baby Food Grocery run for a family Shopping Pick up Parcels Help with Phone or Utility Bill Safe Space Details on the help being offered Help offered for max. Persons Help offered within (miles) Post Pandemic ResourcesAn optional section for you to include the services and resources your organization would regularly offer (if any) to qualified individuals in the community. What resource are you offering? Appointment CoordinatorCareer CounselingChiropractorCoalition or Taskforce GroupCosmetology (hair cuts etc)Counseling ServicesDental ServicesDrop-in CenterDrug/Alcohol RehabEmergency HousingFitness CoachFood and SuppliesInterpretation ServicesLegal ServicesMedical ServicesMental Health CounselingMentorNutrition ServicesOBGYNOther (enter details in notes)Paid Internship OpportunityPhysical TherapyPsychological ServicesReal EstateTattoo RemovalVictim ServicesVictim Services for Minors OnlyLaw EnforcementAwareness and PreventionFinancial Planning Languages Spoken Languages other than EnglishCreoleEnglishFrench (incl. Patois, Cajun)French CreolePortugueseRussianScandinavianSpanishGermanGreekItalianPersianUrduYiddishChineseJapaneseKoreanLaotianMiao HmongMon-Khmer CambodianTagalogThaiVietnameseOther Asian languagesNavajoOther Native North American languagesNigerianArabicHebrewUndeterminedSign Language AmericanSign Language OtherHearing lossSpeech Loss Details on Resource Once you submit this form it will be reviewed by a task force member. A confirmation email will be sent to your email once the review has been completed.