Preliminary application and
pre-assessment form
Thank you for your interest in the First Impressions Program! In order to get to know your community and program needs, we are asking that you complete the following application and send it back with a check for $150.00 made payable to Ohio State University Extension, to:
Vickie Snyder
OSU Extension, East District
16714 SR 215
Phone: 740-732-2381 fax: 740-732-5992 e-mail: snyder.252@osu.edu
You will hear back from us within THREE weeks of our receipt of your application regarding the next steps in proceeding with the program.
Today’s Date:
_________________________________
1. Do you have a
sponsoring organization committed to the First Impressions Program?
q
Yes
q
No
If yes, please check all that apply
q Chamber of Commerce
q Convention & Visitors Bureau/ Office of Travel & Tourism
q Community Organization
q City/ Village Council
q Scenic Byway Coordinator or Corridor Management Group
q
q Downtown Revitalization Group
q Other:
_________________________________________________________
2. What type of survey do you want to undertake?
q Community
q Corridor/ Byway
q Downtown
3. A. If a community, what is
the name and population?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
B. If a corridor or byway, what is the name
and location?
_______________________________________________________________________________________________________________________________________________________________________________________________________________________
4. Location:
Region:
NW NE SW SE Central
Urban_______ Rural________ Suburban_______
5. What is/are your Primary
Objective(s): Check all that apply
q Tourism Development
q Land Use Planning
q Downtown Revitalization
q Business Retention & Expansion
q Economic Development
q Beautification
q Other_____________________
6. Will First Impressions be
part of any other community development program?
q
YES (please
explain)_______________________________
q
NO
7. How do you plan to use the
information you receive?
________________________________________________________________________________________________________________________________________________________________________________________________________________________
8. What do you hope to have as
outcomes of the first Impressions Program?
________________________________________________________________________________________________________________________________________________________________________________________________________________________
9. Name, address, phone, fax and/or
e-mail of the local program coordinator.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________