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Organization/Community Name:
Primary Contact Name
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First
Last
Address
City
Zip Code
Email
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Phone Number
Technical Assistance Needed (Check all that apply):
*
Grant Writing & Funding Strategies
Business Retention & Expansion
Community Health Initiatives
Infrastructure & Transportation
Housing & Economic Development
Public Safety & Emergency Planning
Stakeholder Engagement & Partnerships
Policy & Advocacy
Data & Research Support
Other
Code Zip
Briefly Describe the Assistance You Are Requesting:
What Is Your Preferred Timeline for This Support?
Urgent (Within 2 Weeks)
Short-Term (1-3 Months)
Mid-Term (3-6 Months)
Long-Term (6+ Months)
Additional Information Please provide any other relevant details or considerations:
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