BY ENTERING MY INFORMATION BELOW, I VERIFY THAT ALL OF THE INFORMATION PROVIDED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I HAVE READ AND UNDERSTOOD 2-1-1 SAN DIEGO’S INCLUSION/EXCLUSION POLICY LINKED ON THIS WEBPAGE AND WILL SUBMIT ALL FORMS OF PROOF OF LICENSURE AS REQUIRED BY REGULATING AGENCIES. I ALSO AM AWARE THAT APPLICATIONS WILL BE PROCESSED WITHIN 30-45 BUSINESS DAYS.
I UNDERSTAND THAT IN ORDER TO KEEP 2-1-1 SAN DIEGO’S DATABASE ACCURATE AND UP TO DATE, I AM REQUIRED TO INFORM 2-1-1 SAN DIEGO OF CHANGES TO THE AGENCY’S OPERATIONS WITHIN 30 DAYS.
I UNDERSTAND THAT 2-1-1 SAN DIEGO CONDUCTS AN ANNUAL SURVEY TO VERIFY CURRENT INFORMATION AND THAT IN ORDER TO REMAIN WITHIN THE DATABASE I MUST COMPLY WITH UPDATING THE INFORMATION UPON REQUEST. FAILURE TO COMPLY WITH THESE REQUIREMENTS MAY RESULT IN THE DEACTIVATION OF MY AGENCY OR AGENCIES SERVICES WITHIN THE 2-1-1 DATABASE.