Service/Program Information

Please complete one form for each program provided.

Add additional sheets if necessary.

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If not submitting electronically please mail, email, or fax the completed documents to:

Nevada 2-1-1
Financial Guidance Center
2650 South Jones
Las Vegas, NV 89146
Phone – 702.364.0344
Fax – 702.364.5836

Nevada 2-1-1 reserves the right to edit information for brevity, clarity and content. Your information may be publicly published, subject to confidentiality restrictions.