Local Partnership Request - Montgomery County

*First Name

*Last Name

*Email Address

*Phone Number

*Address Line 1

Address Line 2

*City

*State/Province/Region

*Zip/Postal Code

*Organization Name:

Organization Website

*Where will the proposed work primarily occur?:

*Please provide a brief description of your organization, its mission, and its plan to accomplish its mission.

*Please provide a specific description of the type of partnership in which you are interested—the goals, the plan, the resources required, etc. Please state clearly how you would like MBC to support this partnership (e.g. a certain number of volunteers, or a certain amount of financial support).

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