New Client Intake Form Organization Name * Organization Website * http:// Organization Contact Name * First Name Last Name Organization Contact Email * Organization Contact Phone Number * (###) ### #### Who are the communities you love? * Who and what drives your organization's work? What excites you about your organization's work? * How did you hear about Mirror Group? * What service(s) are you seeking? * Check All That Apply Evaluation Research Facilitation Technical Assistance and Training Strategic Planning Change Management I Don't Know Other What is the impetus/catalyst for the work you are requesting? * Check All That Apply Community Needs Internal Staff Requests Leadership Strategy Partner Interests External Pressures Other What are the intentions for this work? * Check All That Apply Address Immediate Capacity Needs Inform Operations Drive Organizational Systems Change Other What are the deliverables you have in mind for this project? * Check All That Apply Formative Reports Quarterly Reports Annual Report Presentations Capacity Building (Facilitation, Training and/or Technical Assistance with specific audiences) Strategy (next steps action items and/or implementation support based on recommendations from the report) Other Please provide a description of the work you are requesting. * What opportunities do you desire to leverage and/or pain points do you seek to alleviate with the requested work? A short paragraph or bullet point list of 300 words max is fine. Timeline: What is the ideal turnaround time for the requested services? Include details about your preferred start and end dates and critical dates driving this timeline * Example - employee requests, fiscal year budget, change management strategy, board meeting Project Point of Contact(s): What staff (name, position/title) are the points of contact for the requested work? * Financial Resources: What is the budget allocated for the requested scope of work? * If you have an RFP, RFQ, or CFP related to this opportunity, please provide the link here. Thank you for your interest in working with Mirror Group! You will receive an email to communicate next steps within 5-7 business days.
