Fill out the form below to submit your organization to the Dallas IEP. A PCCI representative will be in contact within 48 hours. First Name*Last Name*Organization*Email* PhoneHow did you hear about Pieces Iris or the Dallas IEP?*What is your interest in Pieces Iris or the Dallas IEP?*Does your organization have any affiliation with Parkland Health & Hospital System (PHHS)?* Yes NoIf Yes, Describe how the organization partners with PHHS, e.g. health literacy workshops or client referrals to PHHS.Number of staff members?*Number of Employees or Volunteers who you anticipate using Pieces Iris?*Annual estimated number of clients served?*Does your organization provide programs and/or services in any of the following categories?* Food Assistance Housing Assistance Transportation Assistance Healthcare Education Workforce Training Legal AssistanceOther services or programs provided?Please list zip codes served:*How long has the organization been existence?*Describe why funding is needed?*Describe (or select) your current case management system.*Describe how the adoption of Pieces Iris or the Dallas IEP would facilitate greater impact at your organization.*Please attached audited financial statements/Form 990.