Interested In Becoming A 211 Affiliate?

Please contact us if you are interested in becoming an affiliate of 211 Helpline and wish to be included in our database. Agencies and or organizations must go through a vetting process based on our Inclusion/Exclusion Criteria.

Step #1
Please click to read the Inclusion/Exclusion Criteria before downloading, printing and completing the agency survey form. 
Step #2
Agency Survey Form- after reading the Inclusion/Exclusion Criteria and you feel you meet the criteria sited please download to print the  Agency Survey Form by  Clicking Here. Simply hand print your information on the form.
Step #3
Affiliate Agreement Form- please Click Here to download & print a copy of our Affiliate Agreement Form.  Please sign and include this form with your Agency Survey Form. (Should you be approved our President/CEO will sign off and you will be given a copy.)

Step #4

Attach your completed Agency Survey Form and Affiliate Agreement Form
email to: or
Fax: ATTN: Judi Hechtman to (561) 383-2172 
(Please allow sufficient time for processing before you reach out to us.)

Already An Affiliate & Need To Update Your Information:

It is important that we keep our provider/resource information as current as is possible. We ask that our affiliates immediately  let us know of any changes, whether it be contact info or changes in programs or services.

Please contact:

Judi Hechtman
211 HelpLine
Database Specialist
Tel: 561.383.2162
FAX: 561.383.2172


*Please note that all organizations must meet 211 Palm Beach/Treasure Coast's Inclusion/Exclusion Criteria to be in the database