Form

Interested in developing or participating in a Community Resilience Hub? Fill out this form with information on your organization, facilities, and needs, and we’ll help you get started.

Prior to completing this form, please review the information about Resilience Hubs at https://cecsb.org/resilience-hubs.

First Name*

Last Name*

Email*

Phone Number*

Language*

Business/Organization name*

Facility Street address*

Facility City*

Facility Zip code*

Own or Lease Facility*

Own

Lease

Other

Provide a brief description of the facility you operate*

Enroll Facility in Resilience Hub qualification process*