Beneficiary Needs Survey Facility Name and Department (if applicable) * Mission statement (if applicable) Who do you serve? * Current Contact Person * First Name Last Name Contact Person's Phone Number * (###) ### #### Email Address * Main Facility/Department Phone Number * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Days and Hours Deliveries Accepted Special instructions for delivery. Building number, department, door to enter, any information that would be helpful when delivering blankets. Do you know of another agency in Dallas or Denton County that would benefit from Project Linus blankets? If Yes, please provide the name of the agency. We are always open to new beneficiaries. We welcome questions, comments and additional feedback! Thank you for your feedback!