Need Assistance?
This form should take fewer than 2 minutes to fill out. Please provide as much information as you can. 

We will do our best to help you. Please feel free to call us anytime at (301) 683-8267 or e-mail us at eisenberg@hyattsvillecdc.org with any questions.

We'll be in touch once you're in our queue. Be sure to hit 'Submit' when finished!


New or Returning?
Is this your first time working with us?
Salutation
Your Name *
Point of Contact
Your answer
Business Name (if applicable) *
Or if you don't have a business name, please type your name again.
Your answer
Memorandum of Understanding
By clicking “NEXT” I agree to the following:

"I acknowledge that in seeking CDC assistance, I agree to provide certain, requested information. Some of the information the CDC gathers from me is reported to the Prince George's County Department of Housing & Community Development (DHCD) to assess the impact of its funding on the creation or retention of jobs in our community, including entrepreneurs, businesses, artists, and developers.

I understand that because the CDC's assistance ranges from brief to in-depth, the CDC may or may not include me in their reporting, depending on my needs or timeline.

I understand and agree that this digital application/request form will serve as a written agreement to report and describe: the number and types of jobs I have or intend to create; my hiring process; and the number of low and moderate income people interviewed or hired for a particular position. I understand that the CDC may provide me with survey forms to assist in the collection of data.

I understand that if at least 51% of the jobs I employ or plan to create are held by low and moderate-income persons that I will be included in the CDC’s reporting. I understand the CDC will provide me with a final employee assistance survey to distribute to my employees.

I understand that all of the information I provide is both confidential and secure, and that any employment or demographic data reported is used to build aggregate statistical reporting to DHCD or to confirm the CDC’s assistance activity.

In filling out this request form, I agree to provide such information to the CDC staff so that the CDC can better assess and provide me assistance. If I would like an optional print copy of this MOU, one can be provided for my records.

Select 'NEXT' below and remember to hit ‘Submit’ when finished.

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If you don't believe you can or are unwilling to agree with these terms, please contact Stuart Eisenberg, CDC Executive Director, at eisenberg@hyattsvillecdc.org or call 301-683-8267.
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