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Company/Organization *
Job Title
Email *
Phone Number *
City *
State *
Zip Code *
discuss? Phone to
Organization Type * --- Select Choice --- K-12 School / School District Municipality / Local Government Faith-Based Organization Nonprofit Organization Healthcare Facility Venue / Museum / Cultural Institution Other
Approximate Organization/Facility Size
Number of Facilities/Locations * --- Select Choice --- 1 2–5 6–10 11–25 25+
Do you currently have a specific project identified? * --- Select Choice --- Yes No We are still evaluating our needs
Briefly describe the project or improvements you are considering.
Estimated Project Budget -- Select Estimated Budget -- — Select Estimated Budget — Less than $25,000 $25,001–$50,000 $50,001–$100,000 $100,001–$250,000 $250,001–$500,000 $500,001–$1 Million More than $1 Million Not Yet Determined
Anticipated Project Timeline -- Select Project Timeline -- Immediate / Urgent Within 3 Months 3–6 Months 6–12 Months 12+ Months Not Yet Determined
Are you currently seeking grant funding for this project? -- Select Funding Status -- Yes No Not Sure
Have you identified a specific grant or funding program? -- Select Grant Status -- Yes No
If Yes: What grant or funding program are you considering?
What best describes where you are in the process? -- Grant Progress -- We have identified a concern but don't know what improvements are needed. We know what improvements we would like to make. We have a project planned and are looking for funding. We have identified a grant and need assistance pursuing it. We have received funding and need implementation/post-award support. We are planning for future needs and exploring our options.
Has your organization previously received grant funding? -- Select Grant Experience-- Yes No Not Sure
What would you like us to know before we speak?
