CSBG Statement of Support Yes! We add our names to the Community Action Statement of Support for CSBG! By completing this form, your organization signs onto the Community Action Statement of Support for CSBG. All fields must be completed for your organization's name to be added to the list. Questions? Contact Denise Harlow, Partnership CEO, at dharlow@communityactionpartnership.com. Thank you for your efforts to support full funding for the Community Services Block Grant! OK Question Title * 1. Please complete the following: Name * Organization * Address * Address 2 City/Town * State/Province * ZIP/Postal Code * Email Address of person authorized to add your organization as a supporter * Phone Number of person authorized to add your organization as a supporter * OK Question Title * 2. Are you authorized to sign for your organization? Yes No I don't know Other (please specify) OK Question Title * 3. What is your title? Executive Director/CEO Board Chair/Board President Deputy Director CSBG Director Other (please specify) OK Question Title * 4. Please choose the option that best describes your organization. (Select one) Nonprofit/Private Community Action Agency Public Community Action Agency (local city/county governmental agency, unit of local government) Tribal Government State Community Action Association Regional Community Action Association Local Partner Organization Statewide Partner Organization National Partner Organization Other (please specify) OK DONE