Project or Initiative Intake Assessment

Please help us by filling out this form below:

What is the name of your initiative or project? *

List the goal(s). *

Who are the stakeholders? *

Stakeholders are those individuals, groups, or entities with an interest in or affected by the initiative or project.

Who are the champions? *

Champions are those individuals, groups or entities who are leading or supporting the initiative or project.

How does it support the BPNA Mission? *

Who within the neighborhood is/are working on it? *

Who outside the neighborhood is/are working on it? *

Is there an existing committee structure? If so, describe briefly. *

Provide an estimated date or timeline. (If applicable.) *

If not applicable, then so state.

Provide an estimated budget, including sources of income and expenses. (If applicable) *

If not applicable, then so state.

What is your "ask" of the BPNA? (Choose one.) *

Are you asking the BPNA only to become better aware of the project or initiative? Or, are you asking the BPNA to do something or take an action?

Describe your "ask" of the BPNA specifically and succinctly. *

Name *

First

Last

Email *

Email (Again, to Verify) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Type of Phone *

Message

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