Common use of Basic Directory Information Clause in Contracts

Basic Directory Information. The information below applies to the main organization listing. To add information for a new location or modify or remove information for an existing location, please use Section Six: EN Site Locations. If updating mailing, physical, or website addresses for both the organization and a location please fill out the request in both spots. This information will appear in the online EN Directory and you may be contacted by Ticketholders with the impairments listed. If you serve different impairment groups at different locations, please use Section Six: EN Locations to specify information specific to an individual location. In-person Virtually Both in-person and virtually (listed in EN Directory as in-person) For Profit Sole Proprietor Private Corporation Limited Liability Corporation Private Partnership Other (please specify): Non-Profit Public Private Government Entity State Local Tribal Members of religious minorities (Individuals who belong to communities that face discrimination based on their religion.) Members of the LGBTQIA+ community (Individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity; including lesbian, gay, bisexual, transgender, queer, gender non-conforming, non-binary, LGBTQ+ persons) Persons of color (Individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons) Persons otherwise adversely affected by persistent poverty (Individuals who have income under the poverty line established by the Director of the Office of Management and Budget and revised by the Secretary. See U.S. Federal Poverty Guidelines.) Persons who live in rural areas (Individuals who live in an area other than an area within a metropolitan statistical area or within the outer boundary of any city or town having a population of 20,000 or more) Transition aged youth (Individuals between the ages of 14 and 25) U.S. Military Veterans (Individuals who have served in the military forces and who was discharged or released under conditions other than dishonorable) American Indian Vocational Rehabilitation Agency (AIVR) or Another Organization Serving Indigenous Peoples Center for Independent Living (CIL) Disability Services Representative Organization Easterseals Industries Organization Educational Institution Goodwill Industries Organization Mental Health Care Provider or Other Healthcare Provider Project SEARCH Program State or Local Government Agency (non-SVRA) Workforce Entity (State Workforce Agency (SWA)/ American Job Center (AJC)/ Workforce Development Board (WDB)) The Arc Chapter United Cerebral Palsy (UCP) Affiliate Veterans Affairs (VA) or Veterans Services Other For-Profit Organization (please specify): Other Non-Profit Organization (please specify): Benefits counseling Career planning Employment, i.e., hiring assigned Ticketholders to work for EN or serving as an employer’s agent Entrepreneurship Job placement/job placement assistive services Ongoing employment support/job retention Special language capability (including Braille services and sign language) Please list: Transitional youth Veterans Other (please specify): Cognitive impairments (e.g., mental retardation, Down’s Syndrome, autism, organic brain syndromes, developmental disabilities (including ADD and ADHD)) Hearing impairments Physical impairments Psychiatric impairments (e.g., psychotic, depressive, manic, bipolar, anxiety and/or personality disorders (including eating disorders)) Visual impairments Other (please specify): New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization This section allows you to update information for two EN employees. If you need to add or remove more than two employees, please attach a copy of this section to the form for each additional employee. New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Add new Employee Remove an Employee Add new Employee Remove an Employee

Basic Directory Information. The information below applies to the main organization listing. To add information for a new location or modify or remove information for an existing location, please use Section Six: EN Service Site Locations. If updating mailing, physical, or website addresses for both the organization and a location please fill out the request in both spots. This information will appear in the online EN Directory and you may be contacted by Ticketholders with the impairments listed. If you serve different impairment groups at different locations, please use Section Six: EN Service Site Locations to specify information specific to an individual location. In-person Virtually Both in-person and virtually (listed in EN Directory as in-person) For Profit Sole Proprietor Private Corporation Limited Liability Corporation Private Partnership Other (please specify): Non-Profit Public Private Government Entity State Local Tribal Members of religious minorities (Individuals who belong to communities that face discrimination based on their religion.) Members of the LGBTQIA+ community (Individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity; including lesbian, gay, bisexual, transgender, queer, gender non-conforming, non-binary, LGBTQ+ persons) Persons of color (Individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons) Persons otherwise adversely affected by persistent poverty (Individuals who have income under the poverty line established by the Director of the Office of Management and Budget and revised by the Secretary. See U.S. Federal Poverty Guidelines.) Persons who live in rural areas (Individuals who live in an area other than an area within a metropolitan statistical area or within the outer boundary of any city or town having a population of 20,000 or more) Transition aged youth (Individuals between the ages of 14 and 25) U.S. Military Veterans (Individuals who have served in the military forces and who was discharged or released under conditions other than dishonorable) American Indian Vocational Rehabilitation Agency (AIVR) or Another Organization Serving Indigenous Peoples Center for Independent Living (CIL) Disability Services Representative Organization Easterseals Industries Organization Educational Institution - General Goodwill Industries Organization Mental Health Care Provider or Other Healthcare Provider Project SEARCH Program State or Local Government Agency (non-SVRA) Workforce Entity (State Workforce Agency (SWA)/ American Job Center (AJC)/ Workforce Development Board (WDB)) The Arc Chapter United Cerebral Palsy (UCP) Affiliate Veterans Affairs (VA) or Veterans Services Other For-Profit Organization (please specify): Other Non-Profit Organization (please specify): Administrative, i.e., serve an EN of record for a network of affiliate service providers Benefits counseling Career planning Employment, i.e., hiring assigned Ticketholders to work for EN or serving as an employer’s agent Entrepreneurship Job placement/job placement assistive services Ongoing employment support/job retention Special language capability (including Braille services and sign language) Please list: Transitional youth Veterans Other (please specify): Cognitive impairments (e.g., mental retardation, Down’s Syndrome, autism, organic brain syndromes, developmental disabilities (including ADD and ADHD)) Hearing impairments Physical impairments Psychiatric impairments (e.g., psychotic, depressive, manic, bipolar, anxiety and/or personality disorders (including eating disorders)) Visual impairments Other (please specify): New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Former contact is still working with the organization Former contact is no longer working with the organization (complete Section Four: EN Staff Information) Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization This section allows you to update information for two (complete Section Four: EN employees. If you need to add or remove more than two employees, please attach a copy of this section to the form for each additional employee. New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Add new Employee Remove an Employee Add new Employee Remove an EmployeeStaff Information)

Basic Directory Information. The information below applies to the main organization listing. To add information for a new location or modify or remove information for an existing location, please use Section SixFive: EN Site Locations. If updating mailing, physical, or website addresses for both the organization and a location please fill out the request in both spots. This information will appear in the online EN Directory and you may be contacted by Ticketholders with the impairments listed. If you serve different impairment groups at different locations, please use Section SixFive: EN Locations to specify information specific to an individual location. In-person Virtually Both in-person and virtually (listed in EN Directory as in-person) For Profit Sole Proprietor Private Partnership Private Corporation Limited Liability Corporation Private Partnership Other (please specify): Limited Liability Corporation Non-Profit Public Private Government Entity State Local Tribal Members of religious minorities (Individuals who belong to communities that face discrimination based on their religion.) Members of the LGBTQIA+ community (Individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity; including lesbian, gay, bisexual, transgender, queer, gender non-conforming, non-binary, LGBTQ+ persons) Persons of color (Individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons) Persons otherwise adversely affected by persistent poverty (Individuals who have income under the poverty line established by the Director of the Office of Management and Budget and revised by the Secretary. See U.S. Federal Poverty Guidelines.) Persons who live in rural areas (Individuals who live in an area other than an area within a metropolitan statistical area or within the outer boundary of any city or town having a population of 20,000 or more) Transition aged youth (Individuals between the ages of 14 and 25) U.S. Military Veterans (Individuals who have served in the military forces and who was discharged or released under conditions other than dishonorable) American Indian Vocational Rehabilitation Agency (AIVR) or Another Organization Serving Indigenous Peoples Center for Independent Living (CIL) Disability Services Representative Organization Easterseals Industries Organization Educational Institution Goodwill Industries Organization Mental Health Care Provider or Other Healthcare Provider Project SEARCH Program State or Local Government Agency (non-SVRA) State Vocational Rehabilitation Agency (SVRA) Workforce Entity (State Workforce Agency (SWA)/ American Job Center (AJC)/ Workforce Development Board (WDB)) The Arc Chapter United Cerebral Palsy (UCP) Affiliate Veterans Affairs (VA) or Veterans Services Other For-Profit Organization (please specify): Other Non-Profit Organization (please specify): Administrative, i.e., serve an EN of record for a network of affiliate service providers Benefits counseling Career planning Employment, i.e., hiring assigned Ticketholders to work for EN or serving as an employer’s agent Entrepreneurship Job placement/job placement assistive services Ongoing employment support/job retention Special language capability (including Braille services and sign language) Please list: Transitional youth Veterans Other (please specify): Cognitive impairments (impairments, e.g., mental retardation, Down’s Syndrome, autism, organic brain syndromes, developmental disabilities (including ADD and ADHD)) Hearing impairments Physical impairments Psychiatric impairments (impairments, e.g., psychotic, depressive, manic, bipolar, anxiety and/or personality disorders (including eating disorders)) Visual impairments Other (please specify): New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization This section allows you to update information for two EN employees. If you need to add or remove more than two employees, please attach a copy of this section to the form for each additional employee. New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Add new Employee Remove an Employee Add new Employee Remove an Employeeorganization

Basic Directory Information. The information below applies to the main organization listing. To add information for a new location or modify or remove information for an existing location, please use Section SixFive: EN Site Locations. If updating mailing, physical, or website addresses for both the organization and a location please fill out the request in both spots. This information will appear in the online EN Directory and you may be contacted by Ticketholders with the impairments listed. If you serve different impairment groups at different locations, please use Section SixFive: EN Locations to specify information specific to an individual location. In-person Virtually Both in-person and virtually (listed in EN Directory as in-person) For Profit Sole Proprietor Private Partnership Private Corporation Limited Liability Corporation Private Partnership Other (please specify): Limited Liability Corporation Non-Profit Public Private Government Entity State Local Tribal Members of religious minorities (Individuals who belong to communities that face discrimination based on their religion.) Members of the LGBTQIA+ community (Individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity; including lesbian, gay, bisexual, transgender, queer, gender non-conforming, non-binary, LGBTQ+ persons) Persons of color (Individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons) Persons otherwise adversely affected by persistent poverty (Individuals who have income under the poverty line established by the Director of the Office of Management and Budget and revised by the Secretary. See U.S. Federal Poverty Guidelines.) Persons who live in rural areas (Individuals who live in an area other than an area within a metropolitan statistical area or within the outer boundary of any city or town having a population of 20,000 or more) Transition aged youth (Individuals between the ages of 14 and 25) U.S. Military Veterans (Individuals who have served in the military forces and who was discharged or released under conditions other than dishonorable) AbilityOne Program American Indian Vocational Rehabilitation Agency (AIVR) or Another Organization Serving Indigenous Peoples Center for Independent Living (CIL) Disability Services Representative Organization Easterseals Industries Organization Educational Institution Goodwill Industries Organization Mental Health Care Provider or Other Healthcare Provider Project SEARCH Program State or Local Government Agency (non-SVRA) Workforce Entity (State Workforce Agency (SWA)/ American Job Center (AJC)/ Workforce Development Board (WDB)) The Arc Chapter United Cerebral Palsy (UCP) Affiliate Veterans Affairs (VA) or Veterans Services Other For-Profit Organization (please specify): Other Non-Profit Organization (please specify): Benefits counseling Career planning Employment, i.e., hiring assigned Ticketholders to work for EN or serving as an employer’s agent Entrepreneurship Job placement/job placement assistive services Ongoing employment support/job retention Special language capability (including Braille services and sign language) Please list: Transitional youth Veterans Other (please specify): Cognitive impairments (impairments, e.g., mental retardation, Down’s Syndrome, autism, organic brain syndromes, developmental disabilities (including ADD and ADHD)) Hearing impairments Physical impairments Psychiatric impairments (impairments, e.g., psychotic, depressive, manic, bipolar, anxiety and/or personality disorders (including eating disorders)) Visual impairments Other (please specify): New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization This section allows you to update information for two EN employees. If you need to add or remove more than two employees, please attach a copy of this section to the form for each additional employee. New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Add new Employee Remove an Employee Add new Employee Remove an Employeeorganization

Basic Directory Information. The information below applies to the main organization listing. To add information for a new location or modify or remove information for an existing location, please use Section Six: EN Site Locations. If updating mailing, physical, or website addresses for both the organization and a location please fill out the request in both spots. This information will appear in the online EN Directory and you may be contacted by Ticketholders with the impairments listed. If you serve different impairment groups at different locations, please use Section Six: EN Locations to specify information specific to an individual location. In-person Virtually Both in-person and virtually (listed in EN Directory as in-person) For Profit Sole Proprietor Private Corporation Limited Liability Corporation Private Partnership Other (please specify): Non-Profit Public Private Government Entity State Local Tribal Note: If your organization's mission is to specifically target one of the underserved populations defined below, then you should select all that apply. Members of religious minorities (Individuals who belong to communities that face discrimination based on their religion.) Members of the LGBTQIA+ community (Individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity; including lesbian, gay, bisexual, transgender, queer, gender non-conforming, non-binary, LGBTQ+ persons) Persons of color (Individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons) Persons otherwise adversely affected by persistent poverty (Individuals who have income under the poverty line established by the Director of the Office of Management and Budget and revised by the Secretary. See U.S. Federal Poverty Guidelines.) Persons who live in rural areas (Individuals who live in an area other than an area within a metropolitan statistical area or within the outer boundary of any city or town having a population of 20,000 or more) Transition aged youth (Individuals between the ages of 14 and 25) U.S. Military Veterans (Individuals who have served in the military forces and who was discharged or released under conditions other than dishonorable) American Indian Vocational Rehabilitation Agency (AIVR) or Another Organization Serving Indigenous Peoples Center for Independent Living (CIL) Disability Services Representative Organization Easterseals Industries Organization Educational Institution - General Goodwill Industries Organization Mental Health Care Provider or Other Healthcare Provider Project SEARCH Program State or Local Government Agency (non-SVRA) Workforce Entity (State Workforce Agency (SWA)/ American Job Center (AJC)/ Workforce Development Board (WDB)) The Arc Chapter United Cerebral Palsy (UCP) Affiliate Veterans Affairs (VA) or Veterans Services Other For-Profit Organization (please specify): Other Non-Profit Organization (please specify): Benefits counseling Career planning Employment, i.e., hiring assigned Ticketholders to work for EN or serving as an employer’s agent Entrepreneurship Job placement/job placement assistive services Ongoing employment support/job retention Special language capability (including Braille services and sign language) Please list: Transitional youth Veterans Other (please specify): Cognitive impairments (e.g., mental retardation, Down’s Syndrome, autism, organic brain syndromes, developmental disabilities (including ADD and ADHD)) Hearing impairments Physical impairments Psychiatric impairments (e.g., psychotic, depressive, manic, bipolar, anxiety and/or personality disorders (including eating disorders)) Visual impairments Other (please specify): New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Former contact is still working with the organization Former contact is no longer working with the organization (complete Section Four: EN Staff Information) Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization This section allows you to update information for two (complete Section Four: EN employees. If you need to add or remove more than two employees, please attach a copy of this section to the form for each additional employee. New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Add new Employee Remove an Employee Add new Employee Remove an EmployeeStaff Information)

Basic Directory Information. The information below applies to the main organization listing. To add information for a new location or modify or remove information for an existing location, please use Section Six: EN Site Locations. If updating mailing, physical, or website addresses for both the organization and a location please fill out the request in both spots. This information will appear in the online EN Directory and you may be contacted by Ticketholders with the impairments listed. If you serve different impairment groups at different locations, please use Section Six: EN Locations to specify information specific to an individual location. In-person Virtually Both in-person and virtually (listed in EN Directory as in-person) For Profit Sole Proprietor Private Corporation Limited Liability Corporation Private Partnership Other (please specify): Non-Profit Public Private Government Entity State Local Tribal Members of religious minorities (Individuals who belong to communities that face discrimination based on their religion.) Members of the LGBTQIA+ community (Individuals who belong to communities that face discrimination based on sex, sexual orientation, and gender identity; including lesbian, gay, bisexual, transgender, queer, gender non-conforming, non-binary, LGBTQ+ persons) Persons of color (Individuals who belong to communities of color, such as Black and African American, Hispanic and Latino, Native American, Alaska Native and Indigenous, Asian American, Native Hawaiian and Pacific Islander, Middle Eastern, and North African persons) Persons otherwise adversely affected by persistent poverty (Individuals who have income under the poverty line established by the Director of the Office of Management and Budget and revised by the Secretary. See U.S. Federal Poverty Guidelines.) Persons who live in rural areas (Individuals who live in an area other than an area within a metropolitan statistical area or within the outer boundary of any city or town having a population of 20,000 or more) Transition aged youth (Individuals between the ages of 14 and 25) U.S. Military Veterans (Individuals who have served in the military forces and who was discharged or released under conditions other than dishonorable) Type of Organization: (Select the organization type that best describes your EN) AbilityOne Program American Indian Vocational Rehabilitation Agency (AIVR) or Another Organization Serving Indigenous Peoples Center for Independent Living (CIL) Disability Services Representative Organization Easterseals Industries Organization Educational Institution - General Goodwill Industries Organization Mental Health Care Provider or Other Healthcare Provider Project SEARCH Program State or Local Government Agency (non-SVRA) Workforce Entity (State Workforce Agency (SWA)/ American Job Center (AJC)/ Workforce Development Board (WDB)) The Arc Chapter United Cerebral Palsy (UCP) Affiliate Veterans Affairs (VA) or Veterans Services Other For-Profit Organization (please specify): Other Non-Profit Organization (please specify): What services does your EN or Administrative EN Affiliate Provide? (Please select all that apply) Benefits counseling Career planning Employment, i.e., hiring assigned Ticketholders to work for EN or serving as an employer’s agent Entrepreneurship Job placement/job placement assistive services Ongoing employment support/job retention Special language capability (including Braille services and sign language) Please list: Transitional youth Veterans Services Other (please specify): Cognitive impairments (e.g., mental retardation, Down’s Syndrome, autism, organic brain syndromes, developmental disabilities (including ADD and ADHD)) Hearing impairments Physical impairments Psychiatric impairments (e.g., psychotic, depressive, manic, bipolar, anxiety and/or personality disorders (including eating disorders)) Visual impairments Other (please specify): New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization Former contact is still working with the organization Former contact is no longer working with the organization This section allows you to update information for two EN employees. If you need to add or remove more than two employees, please attach a copy of this section to the form for each additional employee. New EN employees must undergo the suitability process. For more information visit the Suitability section of the Service Provider website at xxxxx://xxxxxxxxxxxxxxxx.xxx.xxx/information-center/suitability.html. Add new Employee Remove an Employee Add new Employee Remove an Employee