Community Health Initiative (CHI) Consulting Project Application (Organization Form)
INCOMPLETE APPLICATIONS AND THOSE ORGANIZATIONS NOT MEETING THE PROGRAM REQUIREMENTS WILL NOT BE CONSIDERED. FOR MORE INFORMATION, PLEASE GO TO THE CHI WEBSITE: https://bced.umn.edu/CHI/Consulting
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General Information
Organization Type (Note: Government agencies, use Nonprofit option) *
Organization Name *
Contact Person (Name, Title and Preferred Pronouns) *
Name of  Executive Director / Business Owner(s) *
Full Address (including Suite#, City, State and Zip Code) *
Phone *
Fax
E-mail *
Web Page
Year Established *
Number of Full-Time Employees *
Number of Part-Time Employees *
Organization Description *
Student Consulting is available in the following areas.  Please check the topical area(s) for which you are requesting consulting services. *
DO NOT CHECK MORE THAN TWO CATEGORIES
Required
**If you are interested in working with a particular student, please provide their name and e-mail address. (NOTE: the Student must also apply and request you for their Consulting Organization.)
Which of the following best describes the setting of your intended project? *
List Project Goals & Objectives: *
Describe your project in DETAIL.  Please be SPECIFIC when describing the scope of this request.  Describe how the results of this project will benefit the community at large as well as the organization.  What valued experiences will the student(s) gain by participating in this project?
List Project Tasks & Timelines: *
List Project Outcomes & Deliverables: *
Please list any specific skills, knowledge or past experiences the student(s) should have to be succesful with this project.
Please share any other information about your organization that would be useful in considering your application.
How did you hear about our program? (Check all that apply) *
Required
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