# Fund for Public Conversation Application Form Questions

Please fill out the following information about your project and we'll get back to you as soon as possible!

- **Name:**
- **Email:**
- **Organization:**
- **Website:**
- **Organization Type:**  
  --None--  
  Community  
  Coalition  
  Library  
  Media  
  Educational Institution  
  Government  
  Foundation  
  Corporation  
  Community Member  
  Other

- **Please provide a summary of your intended project in 250-500 words**
- **Please list your top 3 goals for this project**
- **What is your current relationship with the community you would like to hear from?**
- **How will you share the learnings from your project?**
- **Anticipated start date:**
- **Anticipated end date:**

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**Cortico** is a non-profit 501(c)(3) organization led by a multidisciplinary team of experts in community engagement, technology and non-profit management. We strive to meld two elements not typically found in one space: technological innovation and community-centered advocacy. We'd love to keep you up to date on what we're doing!