Form

Bluesprings Hoke County Community Development Corporation

This form will allow you to add information to be included in the Blue Springs CDC Database which is accessible online.

The form was designed by Ruby Sinreich of NCexChange and slightly modified for Blue Springs by Afi G. Osakwe, Blue Springs Volunteer.

If you have any problems submitting this form, please print it out and fax it to us at 910-904-5948 or email data@bluespringscdc.com .

Please use the "Comments" field to explain if you check 'other.'

Enter the full name of the institution or program.

O r g a n i z a t i o n :

List up to five contacts.
Check the box to the left of the one that should be the first point of contact.

Take as much space as you need.

C o n t a c t s :

First	Last	Title/Department	E-mail

Enter the mailing address of the organization.

Choose the county in which it is located and list the fax and phone numbers and web page information, if available.

A d d r e s s & C o n t a c t I n f o :

Address
City/St./Zip	,
County	if in North Carolina
Phone	Fax
Web	http://

Please choose the scope and type and geographic characteristic of organization.

S c o p e & T y p e o f O r g a n i z a t i o n :

Academic Institution
Bank
Community Action Agency
C-B Development Corporation*
F-B CDO*
Financial Intermediary
Foundation
Government Agency
National Association
National Organization

Neighborhood Housing SO*
Social Services Agency
State/Regional Association
TAP*
Volunteer Center
Funder
Volunteer Individual
Community Center
Library
Health Program

Individual
Hospital
HMO
other

C-B stands for Community-Based, F-B CDO stands for Faith-Based Community Development Organization, SO stands for Services Organization, TAP stands for Technical Assistance Provider

What kind of services does this organization offer to the Community? Check as many as apply.

T y p e o f S e r v i c e s :

human services
web hosting
web development
training
TA, phone, online, site
construction management
entrepreneurial training
CRA advocacy
housing counseling
special needs counseling
housing management
transportation
business plan assistance
equity investor
new office/retail construction
rehab of industrial buildings

info. broker
info.website
public access site
computer lab
advocacy
community organizing
home repair
rehab/weatherization
environmental development
sustainable development
childcare
healthcare
accounting assistance
admin revolving loan fund
rehab of office/retail buildings
office/retail management

hardware recycling
volunteer, individual
volunteer, institutional
arts/cultural programs
job training, placement, retention
youth programs
anti-crime programs
senior citizen programs
loans
financing
production/resale
own/operate businesses
service/package loans for others
new industrial construction
industrial property management
other programs

TA stands for Technical Assistance

Is there a special group that the services are intended for? Check as many as apply.

T a r g e t P o p u l a t i o n:

youth	women	men	low-income	immigrants	refugees
disabled	seniors	gays	minority	African American	European American
Asian	Latino	Multicultural		Pacific Islander	Native American
other

Leave this section blank if your services apply to the population at large.

Please explain any costs associated with the services listed above.

C o s t :

What are main areas of concern for this organization?

I s s u e A r e a s:

Primary Issue Area: (Choose one.)

Additional Issue Areas: (Optional.)

Please check all counties that are served by this organization.
Check 'regional' or 'other' and explain in the Comments field if the service area is not defined by individual counties.

Skip this section if the organization serves the entire state.

S e r v i c e A r e a :

regional other
Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee	Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Gates Graham Granville Greene	Guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln Macon Madison Martin McDowell Mecklenburg	Mitchell Montgomery Moore Nash New Hanover Northampton Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan	Rutherford Sampson Scotland Stanly Stokes Surry Swain Transylvania Tyrell Union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin Yancey

Add any additional information that you feel may be helpful. Please add information for any areas where you selected 'other.'

C o m m e n t s :

Are you interested in Blue Springs CDC Membership?

Mail an application package for the Leadership Development Institute

U s e r I n f o :

your name		*You may use your telephone number if you do not have an e-mail account.*
your e-mail

Click 'submit' to add or update this listing.

Click 'clear' to reset the form.

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Go to NCexChange and provide information for their database.

For more information, please email Blue Springs CDC