Indiana University Bloomington

Indiana Prevention Resource Center (IPRC)

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Request for Services

Thank you for choosing the Indiana Prevention Resource Center.
Please provide us with the following information so we can begin assisting you as soon as possible.
(* denotes required field)

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    First Name *:
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    Last Name *:
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    Organization Name *:
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    Title *:
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    Phone Number *:
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    Fax Number:
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    E-mail *:
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    Mailing Address *:
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    City *:
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    State *:
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    Zip *:
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    County:
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    Best way to contact you?
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    Area of Assistance Needed *:
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    Please provide the specifics and details of your project. Include any grant deadlines or requirements that may apply.
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    Have you used the IPRC before?
    Yes
     
    No
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    Does your organization serve Indiana?
    Yes
     
    No
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    Is the organization tax exempt under IRS code 501 c 3?
    Yes
     
    No
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    How did you hear about the IPRC?
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