Is your org a 501(c)(3)? Yes No - Stop here! Must be 501c3

Do you have 10+ employees? Yes No - Stop here! You must have 10+ FTEs

What is your top workforce issue? Budget Management Claims Management Compliance/Employment Law Employee Training Turnover

Do you have a dedicated HR person? No Yes

First Name

Last Name

Title

Email

Phone

Organization

Zip

Estimated # of Full Time Employees

Estimated # of Part Time Employees

Gross Annual Wages

Do you pay state UI taxes? Pay Taxes Reimbursing for Claims

How did you hear about UST?

Priority Code (if any)

Comments