This form allows an agency to request to be added to the statewide database. For assistance, call Harry Graves at 423-398-6064 (M, T, W, Th, F; 8AM-2PM).  

Agency Survey

Agency Survey/Application
  • Date Format: MM slash DD slash YYYY
  • Hours of Operation
  • Counties, Cities and/or Zip Codes (One Per Line)
  • One Per Line
  • Choose One