PUBLIC SERVICE REQUEST FORM

Center for Community Design and Preservation at the College of
Environment and Design at the University of Georgia

Contact Information:
Name of Organization:

Type of Organization:
select one Public, town, city, special district Private, non-profit other (explain) explain:

Name/Title of Contact Person:

Phone number:          Best time to call:
   

Fax number:               
   

Address:

City:                               State:
   

Email address:

How did you hear about the CCDP Office?

Project Service Area:
Who will be served by this project?
select one Members of the Organization Entire Neighborhood Entire City or Town A specific target group, what group? Other, explain: explain:

Project Outline:
Please give a description of the project (ie: nature of the project, location andapproximate size of the site), how it would be a benefit to the community and tothe students who work on it. Detailed information will help us in project selection.Please feel free to attach copies of the site boundaries, photos, maps or anythingelse that would help us to visualize the project area.

Title of Project:

Description

Private Sector:

Have you discussed the project with a private consultant (ie: a professional architect,landscape architect, planner, etc.)?

Yes No

Please explain:

Funding:

What is your group's approximate yearly budget?

How much has been set aside for conceptual work on this project?

Time Frame:
What is the time frame required for the completion of tasks by CCDP?

(Please note that the CCDP office is able to oversee only a certain number of projectsat any one time. Given our limited staff and semester system, if your requestis approved, it may take us several months to initiate the project. Please plan accordingly.)