ATLAS-4

Partner Registration

Organization Name

Address

Apt/Suite

Partner Organization Overview

Partner Organization Logo

Partner Mission Statement

Population Served

Referral Requirements

Office Hours

Website Address

Partner Point of Contact First Name

Partner Point of Contact Last Name

Partner Point of Contact Job Title

Partner Point of Contact Email

Partner Point of Contact Phone Number

Password

Password Confirmation

NOTE: As your registration is submitted Ventura County WD Board reviews and approves, partners will be required to identify organization locations and add tags (service descriptions) in the system. Tags are keywords attached to your organization's services, helping users find relevant information. For example, if your organization offers shelter services, using the tag 'shelter' makes it easier for others to locate related services.

The Ventura County WD Board accepts electronic signatures as legally binding and equivalent to handwritten signatures to signify an agreement where Ventura County WD Board or state or federal regulations or laws require a handwritten signature. Ventura County WD Board partners (subcontractor) with Programs and/or Services acknowledges and agrees to use the ATLAS Electronic Signature when completing required online forms, agreements, and acknowledgments through the ATLAS platform.

Please Sign

Clear Signature

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