Request for Consultation Services
Maddie's® Shelter Medicine Program at Cornell University
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Name of person completing form *
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Position within organization *
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INQUIRING ORGANIZATION
Name of Agency *
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Physical Address *
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City *
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State *
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Zip code *
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County in which brick & mortar structure is located. *
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How many facilities does your organization operate?
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Please describe your reasons for requesting a consultation. *
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Please describe your goals for this consultation. *
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Has this agency previously worked with a consultant, assessment, or advisory team? If so, please describe.
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What would be the preferred time frame for this consultation? *
If requesting a targeted consultation, which topic(s) would this consultation address? *
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