Community Partners Application Date* Date Format: MM slash DD slash YYYY Business Name* Contact Name* First Last Contact Business Title* Email* Phone Website If applicable. Business Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your business's industry, field, or focus?* What is your business's mission statement?* Why would your business work well in the Community Partners Program? What perk or discount could you offer Common Market Owners?* What are ways your business demonstrates sustainable practices, a support of the local community, a promotion of health and wellness, and/or an engagement in educational or charitable practices?*
