Executive Service Corps of the Lehigh Valley

Services

Client Request for Assistance

Download Client Request for Assistance

Fill in the form below to request assistance from the Executive Service Corps of the Lehigh Valley. Please send copies of the following with this request:

	Brochures and other communication pieces
	List of board of directors and committees
	Budget for current year, latest P&L statement and balance sheet
	Organizational chart
	IRS 501 ( c ) (3) determination letter

Please send additional materials to: ESCLV, PO BOX 428, Emmaus, PA 18049, esclv@ptd.net

Your Information ( * = required )

First Name: *

Last Name: *

Email Address: *

Work Information

Street Address: *

Apt, PO Box, Suite etc.:

City: *

State: *

Zip: *

Country:

Organization Phone: *

Organization Name: *

Executive Director: *

Board Chair: *

How did you hear about the Executive Service Corps of the Lehigh Valley?: *

General Mission of Your Organization?: *

Major Activities and Services: *

Annual Budget: *

Major Funding Sources: *

Number of Professional Employees: *

Number of Clerical Employees: *

Number of Volunteer Staff:

Description of Service Needed: *

Date Assistance Needed: *

Month:

Day:

Year:

Name and Title of person(s) ESCLV will be working with: *

Have you received technical assistance in the last two years? If yes, please describe:

Additional Comments:

Date Submitted: *

Month:

Day:

Year:

I want to join your email/mailing list.

PO Box 428, Emmaus, PA 18049 phone: 610-504-6199 / fax: 610-439-2366 esclv@ptd.net
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