CDPC S&F Intake Questionnaire First and Last Name * Organization Name * Street Address, City, and State * Zip Code * Phone Number where we can contact you during the day * Email address * What communities, topics are your programs and priorities focused upon? (Women, Children, Native Americans, Rural, Urban, etc.) * Describe your organization. (Is the business structure for profit, non-profit, informal association, coalition, etc.) * Business Infrastructure and Support - Choose which type of funding you are interested in: * Business Funding (startup capital, expand business, home-based business, inventions, etc.) Real Estate Investing/Business (new construction, rental properties, commercial, etc.) Community Funding (performing arts, humanities, crime prevention, disaster relief/prevention, etc.) Education/Tuition Funding (tuition, student financial aide, scholarships, research, etc.) OtherOther How much money are you going to need? * $500 - $10,000$10,000 - $25,000$25,000 - $50,000$50,000 - $100,000$100,000 or more Describe what you will use the money for... * Tell us some unique things about your organization. * What email address would you like to use for your USERNAME for your CDPC online access? (Your email is safe We hate spam as much as you do. Your email will be your username for the CDPC website. Please double check it to be sure it is correct!) * If you are human, leave this field blank. Submit
