THANK YOU FOR SEEKING ASSISTANCE FROM THE BLACK DIAMOND RC&D
COUNCIL. PLEASE COMPLETE THE FOLLOWING QUESTIONS, WHERE
APPLICABLE, IN AS MUCH DETAIL AS POSSIBLE, SO THAT WE MAY
CONSIDER YOUR REQUEST.
Project Manager: Designate a single individual (All communications regarding
this project will be directed to this person.)
Name: ______________________________________________________________________
Position/Title: ________________________________________________________________
Address: ____________________________________________________________________
Phone: ________________________________ Fax: ________________________________
Email: ______________________________________________________________________
Representing:
Organization/Business: ________________________________________________________
Legal Status: 501 (c) 3 ________ 501 (c) 4 ________ 509(a) ________
School: ________________________________________________________________
Unit of Government: ______________________________________________________
Other: _________________________________________________________________
1) Provide a brief summary of the project:
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2) Specifically, what assistance do you need from the Black Diamond RC&D?
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3) How long have you or your organizatrion been working to accomplish this effort?
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4) What accomplishments have been made to date?
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5) What other resources have you pursued and what were the results?
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6) What benefical results do you expect your project to bring to the area covered by the Black Diamond RC&D?
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7) Other comments:
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PLEASE MAIL YOUR REQUEST TO BLACK DIAMOND RC&D COUNCIL, 383 HIGHLAND DRIVE,
SUITE 2, LEBANON, VA 24266 OR FAX IT TO 276-889-4246. THE BLACK DIAMOND RC&D
COUNCIL WILL REVIEW YOUR REQUEST AND RESPOND AS SOON AS POSSIBLE. IF YOU
HAVE ANY QUESTIONS PLEASE CALL US AT 276-889-4180.
Proposed by: ________________________________________________ Date:______________________________
RC&D Programs and services are offered on a non-discriminatory basis, without regard to race, color, national origin, sex, age,
marital status or handicap.
