Public Allies Pittsburgh Placement Partner Interest Form
This form is intended for anyone interested in hosting a Public Ally. Public Allies are available Monday-Thursday to help create, improve, and expand your organization's services. Naomi Tannenbaum (Site Director, Public Allies Pittsburgh) will follow up to formalize the terms of the partnership. If you have additional questions, please contact Naomi at naomit@publicallies.org or 412-201-5772.
Organization Name *
Your answer
Organization Website
Your answer
Street *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Contact First Name *
Your answer
Contact Last Name *
Your answer
Contact Email *
Your answer
Contact Phone *
Your answer
Are you a 501(c)3; government agency; or 501(c)4 or 501(c)6 that does not engage in lobbying activities as defined under the Lobbying Disclosure Act of 1995? *
Have you hosted an Ally before? *
Does your organization provide services that focus on any of the following areas? *
Check all that apply.
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of CORO. Report Abuse - Terms of Service