DDC Project HELP Application

Dungannon Development Commission, Inc
P.O. Box 174
Dungannon, VA 24245
Phone: (276) 467-2306
Fax: (276) 467-2665
E-mail: Dungannon_DDC@hotmail.com
Web site: www.ddcinc.org

Organization's information:

Organization:

Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Organization's web site:

Contact person information:

Name:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
Email address:

Group information:

Has this organization ever been to the phoenix center before?
If yes, what year?
Total number of people in group:
Total number of adults in group:
Total number of youth in group:
Desired date of arrival:
Desired date of departure:
Does any member of the group have the following skills: Carpentry
Masonry
Dry Walling
Other

To better accomodate our group(s) we ask that you answer the follwing questions:
Do any members have disabilities:

Do any members have any special dietary needs: