Adopt-A-Worker Program (AAW) Faith-Based Organization's Registration
Organization/Congregation Name: Address: City: State: select.... AL AK AS AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip: Phone Number: Organization/Congregation email: Organization/Congregation web page: Congregation's AAW Liaison*: Liaison's Phone Number: Liaison's email: County of OKDHS Office: *Person coordinating the Adopt A Worker program at the Faith-Based organization.
OKDHS Phone Number: OKDHS AAW Program Contact (if any): Program Contact's email address: OKDHS Adopted Worker: Approximate Date of "Adoption": Program Comments: