City of Charlotte

corporatecommunications1@ci.charlotte.nc.us

600 East Fourth Street, , Charlotte, NC, 28202, US

704-336-7600

Receipt

You will be provided with a Receipt upon submission.

JumpStart Community Safety Summit

Phone Number

Organization Name

What best describes your role in the community?

Funder

Grassroots Leader (does not get paid for their work and is not affiliated with a neighborhood organization)

Neighborhood Leader (does not get paid for their work and is affiliated with a neighborhood organization)

Non-Profit Leader (volunteer, staff or board member of a non-profit organization)

Other (please specify)

Which of the following JumpStart themes interests you the most?

Crime Prevention

Conflict Mediation

Opportunities for Youth & Parents

Family Stability

Addressing Racial Segregation

Do you have any dietary restrictions?

none

Vegetarian

Vegan

No red meat

halal or kosher

nut allergy

gluten free

other

Please enter the primary zip code in which you do your work

Are you a current or previous grantee?