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Request for Proposal from Northstar EAP
Please fill in these questions so we can build a custom proposal for your organization.
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* Indicates required question
Name of Person filling out this form:
*
Your answer
Email of Person filling out this form:
*
Your answer
Preferred phone of Person filling out this form:
Your answer
What date are you filling out this form?
*
MM
/
DD
/
YYYY
What is the name of your organization?
*
Your answer
What is the type of organization?
*
Education
Manufacturing
Banking or Finance
Healthcare
Tech or IT
Retail/Sales/Food or Service Industry
Non-profit
Small business (under 50 Employees)
Other:
Required
How many people are employed at the organization?
*
Your answer
What is the business address of the company?
Your answer
Do you work with a broker for benefits or insurance?
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Yes
No
(If yes to above) What is the name of your insurance company and benefit broker?
Your answer
What is your brokers phone or email?
Your answer
Do you currently have an EAP?
*
Yes
No
If yes to the question above what is the name of the group?
Your answer
Requested services from Northstar:
*
Employee Assistance Programming
Human Resources Consulting
Employee or Supervisor Training or Seminar
Employee or Leadership Coaching
Other:
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