Form

Project EmpowHER - Become a Partner & Request Period Products

Organization Name

Organization Address

Organization Website

Contact Name and Title

Contact Email Address

Contact Phone

When would your organization generally be available to accept deliveries? (e.g. Monday-Friday, 10:30-2:30)

Please provide a brief summary regarding your request for partnership to include: the goals for this partnership, what is the population to be served through this partnership. (Demographic info regarding the total number of individuals to be served, age ranges, etc. is bery helpful to our team.)

Where and when would this partnership take place?

How would this partnership support the strategic goals of Project EmpowHER?

Thank you for your interest in Partnering with JLOC's Project EmpowHER!

A member of the Project EmpowHER committee will be in touch regarding your request.

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