CONTACT INFORMATION FORM

Please fill out the form below for contact information describing your organization or individual services.  Please use the "Comments" areas to explain all "Other" selections.  Feel free to make suggestions or comments.  Thank you. * = Priority Info

 
Organization Name:

 

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Contact Person:

 

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Address:

 

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City:

 

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State:

 

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Zip Code:

 

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Phone:

 

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North Carolina County:

 
Fax:

 
Organization Email:

 

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Organization URL:

 

 * (of course, if you have one)
Organization Scope:

 
Organization Type:

 
Organization Focus:

 
Industry Type:

 

 Academic Institution Affordable Housing Bank Faith-Based Community Action Agency Community Center Community Development Corporation Financial Intermediary Foundation Government Agency Funder Health Program Individual Hospital HMO Library National Association National Organization Social Services Agency State or Regional Association Volunteer Center Other

 
Type of Services:

 

 

 Accounting Assistance Child Care Community Revitalization Human Services Housing Counseling Construction Management Rehab and Weatherization Web Hosting Web Development Technical Assistance Training Home Repair Public Access Site Info Broker Info Website Computer Lab Sustainable Development Health Care Rehab of Office and Retail Buildings Community Organizing Advocacy Environmental Development Admin Revolving Loan Fund Office Retail Management Help Line Entrepreneurial Training Special Needs Counseling CRA Advocacy Business Plan Assistance Transportation Equity Investor Venture Capitalist Rehab of Industrial Bldgs New Office and Retail Construction Other

 
Target Population:

 

 Youth Women Men Low Income Immigrants Refugees Disabled Seniors Gays Minority Specific Other
 

 

 

Comments: