Global Shaper Partner Organization Information
Thank you for your interest in working with the Chicago Global Shaper organization! Please complete this form to help us understand the project work who would be a good fit for your organization. The information provided on this form will be shared with the members of our hub.
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Email *

CONTACT INFORMATION

Information for the point of contact that the hub will be working with during the duration of our project. 
Name *
Position *
Email *
Phone *
LinkedIn Profile *
Brief Professional Biography

HOST ORGANIZATION INFORMATION

Type of Agency *
Required

Populations Served

 *
Required
Services Provided *
Required
Organization Name *
Organization Mission *

Host Organization Full Address: (Street Address, City, State)
 *
Host Organization Website *
Organization Description
 *
2 to 3 paragraphs about your organization.
Size of Team *

Potential Project Work
 *
A copy of your responses will be emailed to the address you provided.
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