Expression of Interest Form

Testing Solutions for Check Yourself HIV/STI Testing Initiative

We appreciate your attention to our Request for Proposal (RFP) for Check Yourself HIV/STI Testing Initiative. To facilitate the proposal evaluation process, we kindly seek your Expression of Interest by providing the requested information below before April 10th, 2024, 12pm EST (noon). Although your response to the form is non-binding, it greatly assists us in planning for the evaluation.

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* 1. Today's Date

Date / Time

Date

Time

AM/PM

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* 2. Expression of Intent: Please select one of the following.

Intend to submit proposal

Do not intend to submit my proposal

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* 3. Laboratory Name

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* 4. Address

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* 5. Contact Name

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* 6. Title

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* 7. Email

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* 8. Phone Number

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* 9. Faith-based Organization?

Yes

Expression of Interest Form

Testing Solutions for Check Yourself HIV/STI Testing Initiative

Question Title

* 1. Today's Date

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* 2. Expression of Intent: Please select one of the following.

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* 3. Laboratory Name

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* 4. Address

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* 5. Contact Name

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* 6. Title

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* 7. Email

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* 8. Phone Number

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* 9. Faith-based Organization?

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* 10. Any supplementary information or comments you provide will be valuable: