Helpline Center Directory Intake Form
  • Choose the option that best applies:

  • Intake for Government Offices

    If you are from a city, county, state, or federal office, please complete the following to be registered for the Resource Database through the Helpline Center.

  • Intake for Non-Profit Agencies/Programs

    Complete one form per program. Please keep the description short but comprehensive in listing your services. The Helpline Center and 211 Resource Database staff reserve the right to edit information to match our style guidelines.

  • Intake for For-Profit Agencies/Programs

    Complete one form per program. Please keep the description short but comprehensive in listing your services. The Helpline Center and 211 Resource Database staff reserve the right to edit information to match our style guidelines.

  • Intake for Native American Agencies/Programs

    Complete one form per program. Please keep the description short but comprehensive in listing your services. The Helpline Center and 211 Resource Database staff reserve the right to edit information to match our style guidelines.

  • Intake for Mental Health/Substance Use Providers

    Fill in the fields below to get listed in our resource database and/or behavioral health guides (where applicable). Please note - Without a license or credential in behavioral health, a resource may be listed in 211 Resource Database, but may be excluded from area specific guides. The Helpline Center and 211 Resource Database staff reserve the right to edit information to match our style guidelines. Email database@helplinecenter.org with any questions.
  • Does this organization serve all or part of South Dakota?*

  • Unfortunately, because your coverage area does not include South Dakota you are ineligible for the South Dakota 211 database. Please visit www.211.org to find the provider for your area.

  • Is this a short-term program (grant funded and program will end eventually):
  • Identify specific services; these will then become part of your description after the overview (check all that apply):

  • For sample description of government offices, please click here. Please copy/paste the correct desciption and make any edits, if need for your specific department.

  • Select category of services offered (select all that apply):*
  • Does this resource accept donations of certain items? The 211 resource database will not list "Accepts monetary donations" or "Donations of time/volunteers" on any record:*
  • Do you offer pick-up for donations?
    • Tell us about you! 
    • Gender of Mental Health Provider(s):*
    • Communities Served 
    • What age ranges do you serve (Select all that apply):*

    • Sometimes clients seek out therapists that share experiences with issues of gender, community, etc. The following information is not shown on your listing, but can be used to help clients better search for a provider.

    • Ethnicity of Mental Health Provider(s):*
    • Faith Orientation:
    • Finances 
    • Insurance (if you're in-network with any insurance companies, select them here:

  • Please list all sites below. To include additional sites, click on the "Add another site" button at the bottom of the entry. Repeat this until all sites have been added.

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Do you want this email marked as private (not viewable by the public)?
  • An annual update of program information is required. Who will be the annual updater?*

  • This signed release form will be kept on file as an ongoing authorization that the Helpline Center, Inc. may provide information to the public regarding the above-mentioned agency/organization. In addition to relaying information over the telephone, the Helpline Center, Inc. also disseminates information in a variety of printed and electronic formats including, but not limited to, human service directories, community resource sections in telephone books, computer disks, the Internet, and mailing lists/labels.

    The above-mentioned agency/organization agrees to inform the Helpline Center, Inc. of any changes or discrepancies it makes or discovers and is solely responsible for keeping the Helpline Center, Inc. informed of changes, which may be needed in the information. This agency agrees to provide the Helpline Center, Inc. with updated information when it is requested.

    This document shall be considered in place and valid until such time as the above-mentioned agency informs the Helpline Center, Inc. in writing that it is terminated.

    The Helpline Center, Inc. has an inclusion policy that states “inclusion in the Helpline Center, Inc. database should in no way be construed to constitute an endorsement of an agency or organization or its service, nor should exclusion be construed to constitute disapproval. The information that appears in the Helpline Center, Inc. database is provided by the agencies and organizations. We make no representation with respect to the completeness of the information. The Helpline Center, Inc. reserves the right to remove or exclude any organization from the Helpline Center Inc. database for any reason. Inclusion in the Helpline Center, Inc. database is a privilege rather than a right.”

  • Clear
  • Should be Empty: