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Community Data Analysis Intake Form
Q1.
Name of Community:
Q2.
Contact Person (Primary):
Name
Address
City
State
Postal code
Phone
Email
Q3.
Contact Person (2):
Name
Address
City
State
Postal code
Phone
Email
Q4.
Are you interested in having a Community Data Analysis in your community?
Yes
Maybe, but I need more information
No
Q5.
Please provide the following parameters:
Community Data Analysis Proposed Dates
Alternate Dates
When Report is Needed
Q6.
What are the desired outcomes of the Community Data Analysis?
Q7.
How did you hear about the Community Data Analysis Program?
Q8.
Would you like to see an example report from a past analysis?
Yes
No
Q9.
Our WVU Extension Service Economics Specialist will contact you to provide more information and/or discuss the possibilities of a Community Data Analysis in your community.
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