Are you interested in partnering with Indiana State University on a future initiative? If so, we'd love to hear from you. Please submit the information below, and someone from Indiana State University's Center for Public Service and Community Engagement will get in contact with you about your request. To follow up or for more details, contact the Center at (812) 237-7900 or cpsce@indstate.edu.

Business or Organization Information:

Business or Organization Name: (Required)

Address:

City:

State:

Zip Code:

Phone: (Required)

Fax:

Website Address:
(if applicable)

Contact Person/Representative Information:

First Name: (Required)

Last Name: (Required)

Email:

Phone: (Required)

Brief description of business or organization's purpose or mission:

Name or title of partnership opportunity:

Brief description of partnership details:

Project start date:
		Month	Day	Year

Project end date:
		Month	Day	Year