"Mapping" Local Institutions
Please fill in the following information. Institution Name:_________________________________________________________ Address:______________________________________________________________ City:_____________________________ STATE:_______________ZIP_____________ Phone:____________________________ FAX:________________________________ E-mail address:__________________________________________________________ Service Area:___________________________________________________________ Mission: _______________________________________________________________ ______________________________________________________________________ Primary Programs:________________________________________________________ _______________________________________________________________________ Contact Person:___________________________________________________________
Expertise:________________________________________________________________
Financial Capacity: Special funding resources specific to your organization that can include community groups:___________________________________ Intern Jobs:___________________________ Job Training Site:_____________________# of Employees___________________________ Programs:__________________________________________________________________ ____________________________________________Participants per year:_________ Programs:__________________________________________________________________ ____________________________________________Participants per year:_____________ Services___________________________________________________________________ Services___________________________________________________________________ Services___________________________________________________________________ Services___________________________________________________________________ Services___________________________________________________________________ Services___________________________________________________________________ Products:__________________________________________________________________ Products:__________________________________________________________________ Information/Data that assists in communities problem solving: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Mapping
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