Faith-Based Community Partnership Registration

Please complete the following form in order to be added to our list of faith-based organizations in Westchester. An asterisk (*) indicates required information.

The information submitted to us will never be shared; will always be kept confidential; and will never be used in any other county government application.

Upon completing and submitting the form, you'll receive an automated e-mail acknowledgement of what was submitted. If you need to update this information at any time, please resubmit the complete information using this same form and check the box indicating the information is updated.

For example, Catholic, Catholic-Orthodox, Protestant, Muslim, Jewish, Jewish-Reformed, Protestant-Presbyterian, etc.
General or informational e-mail address for organization, if applicable.
Enter name of chief officiant
If different from the chief officiant
If the officiant or the contact person has an e-mail address different from the general e-mail address, please enter it in this field.
If the officiant or contact person has a phone number different from the general phone number entered above, please enter it this field.
You may select multiple choices by holding down the CTRL key and clicking on the appropriate options. If other is selected, please succinctly list what other services your organization offers in the box below.
If you are updating your information, please complete the entire form so we have all your information together in one submission. Thank you.

To submit this form, you must enter the random verification code in the field below.