2. 
3. LYON COUNTY HUMAN SERVICES Community Resource Directory Addition / Revision Request Form
   To request additions or report revisions to the Lyon County Human Services Community Resource Directory, complete and submit this Addition/Revision Request form.
5. Agency:*
6. Date:*
   Date:
7. Type of Request:*

   1. New Resource
   2. Update / Remove Resource
9. Contact Name:
10. Phone Number:*
11. Email:
15. Resource Category:
17. Name of Resource/Service:
19. Address1
21. Address2
23. City
24. State
25. Zip
27. FAX Number:
28. Email:
30. Description of Services Offered:
34. Explain how you became aware of this resource, or reason for change or removal:
38. What Happens Next...
    Thank you for submitting this form to update the Community Resource Directory. Your request will be submitted for approval. Please email this completed form to lchs@lyon-county.org. Once your submission goes through the approval process, the change will be reflected on the online Lyon County Resource Community Resource Directory. Thank you for your commitment to serving our community with the most current and correct information.
42. ADMINISTRATIVE SECTION
44. Date Resource Verified:
    Date Resource Verified:

    Date Resource Verified:
48. MANAGEMENT SECTION
50. Approval:

    1. Approved
    2. Not Approved
51. Approving Authority:
53. Comments:
57. Date Resource Added/Revised:
    Date Resource Added/Revised:

    Date Resource Added/Revised:
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit Submit and Print

* indicates a required field