This form is used by agencies/companies that would like to pursue potential opportunities to partner with the Resident Services Department. A Resident Services staff member will follow-up regarding next steps.

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* 1. Agency/Company Name:

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* 2. Agency/Company Website:

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* 3. Name-Lead Contact for Response:

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* 4. Email-Lead Contact:

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* 5. Phone-Lead Contact:

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* 6. Who do you serve? Please describe specific target communities, regions and/or populations.

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* 7. In terms of pursuing a partnership with the Resident Services Department, what is your agency/company most interested in?

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