Organization_and_Contact_Information_Attachment_3_-_FINAL.pdf
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- NIHDA201800065
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Attachment 3: Organization and Contact Information
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Attachment 3
NIHDA201800065
NIMH OUTREACH PARTNERSHIP PROGRAM
Organization and Contact Information
Complete the following information about the prospective offeror’s organization.
Organization Name:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Website URL:
Organization Email Address:
DUNS:
Project Manager Enter contact information for the person who will be the primary point of contact to NIMH and responsible for management of the organization's work for the NIMH Outreach Partnership Program.
Prefix:
First Name:
Last Name:
Degree(s):
Title:
Organization:
Street Address:
City:
State:
Zip Code:
Phone:
Email Address:
Project Manager Assistant Enter information for the person who will serve as the project manager assistant for the Program.
Prefix:
First Name:
Last Name:
Degree(s):
Title:
Organization:
Street Address:
City:
State:
Zip Code:
Phone:
Email Address:
| Organization and Contact Information |
| Project Manager |
| Project Manager Assistant |
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