Contribute to Prompt Payment Efforts

1.Organization Name:
2.Your Name:
3.Your e-mail address:
4.Can we publish your organization's name in our report to the State of Alaska? (Your answers will remain confidential if you select no)
5.Which part of the state are your services delivered? (select all that apply)
6.Which state department do you receive funds (grants/contracts) from?
7.In the last two years, what is the maximum length of time that your organization has waited for payment?
8.What is the amount of funds have you waited for (or are currently waiting for)?
9.Briefly describe the impact of the delayed payments:
10.Are you willing to testify before the Alaska State Legislature if needed?