Community Engagement Request Form
Request Details
Name of Requester
First Name
Last Name
Organization/Group Name (if applicable)
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Engagement Purpose
Purpose of Engagement
Brief Description
Community Details
Target Community
Community Size
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Engagement Details
Type of Engagement
Event
Workshop
Outreach
Other
Date and Time
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Duration
Hour Minutes
Collaboration and Partnerships
Existing Partnerships
Indicate if there are existing partnerships or collaborations related to the engagement
Desired Partnerships
Specify any desired partnerships or collaborations for the proposed engagement
Logistics
Equipment/Resource Needs
List any specific equipment, resources, or materials needed for the engagement
Volunteer Requirements
Specify if volunteers are needed and any specific requirements
Community Benefits
Expected Benefits for the Community
Describe the anticipated benefits or positive outcomes for the community
Long-Term Impact
Explain any potential long-term impact or sustainability measures
Submit
Should be Empty: