Inbound Inquiry Demo (English)

The live version of this form has been moved to:

https://system.environmentalprotectionnetwork.org/inbound-request/

Spanish version: https://system.environmentalprotectionnetwork.org/inbound-request-form-spanish/

——- below is the demo form —–

The Environmental Protection Network (EPN) provides pro bono capacity-building technical assistance to frontline communities, nonprofit organizations and under-resourced state/local/Tribal government agencies.

Please tell us about your situation and we'll reach out soon.

Versión en español

To begin, please tell us about yourself

Your Name:

Your Role Title:

Your Email:

Your Telephone Number:

Urgency of this request

Is this request urgent?:

Yes, it’s Urgent

This is Non-urgent

Next please tell us about your Organization

Your Group/Organization Name:

Please select the type of group or organization you represent:

Your Organization's website address (if it has one):

Your Organization's Facebook Page (if it has one)

Your Organization's X Handle (if it has one)

US State/Territory:

City:

Tribe/Tribal Consortia:

Technical and Funding Assistance

We have a Technical Assistance request (for example, help navigating or understanding government programs, data, or processes; or gaining access to partners, allies, or decision-makers)

We are seeking assistance with a Federal Grant application

We have been selected for a Federal Grant and we need assistance with compliance, termination, freeze, and/or implementation

We are seeking development/fundraising assistance (including identifying potential funding, or reviewing grant applications)

How did you find us?

How did you hear about this technical assistance program and/or center?

Tell us about your issue and the assistance you are seeking

Please provide a general description of the issue and what assistance you are looking for:

Select Subject Matter(s) if known: Air monitoring Drinking water Flooding Petrochemicals Superfund Lead EPA Grants DOE Grants Carbon Capture Sequestration

Do you consider the residents you serve, or the community you live in, to be a Disadvantaged Community?

Please provide any additional comments or concerns regarding your request:

Confirm and Send Request

The information you have shared above will be sent to EPN for review, and assignment to a Technical Assistance associate.

Please review the information you have entered above (especially your email and phone number) and then click the Send Request button below to submit this request.