SW1025 Agency

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Agency Number

Agency Name

Address Line 1

Address Line 2

City

State

Zip Code

Agency Contact Name

Agency Contact Email

Agency Contact Phone Number

BRIEFLY DESCRIBE YOUR PROJECT'S SCOPE AND REQUIREMENTS INCLUDING IF KNOWN A TIMELINE, PART TIME/FULL TIME DESIGNATION AND NEEDED DELIVERABLES:

IDENTIFY IF YOU HAVE ANY SPECIFIC REQUIREMENTS FOR THE RESOURCE(S) SUCH AS LEVEL OR YEARS OF EXPERIENCE, REMOTE WORK VS ONSITE:

PROVIDE THE ANTICIPATED COST AND/OR THE BUDGETED AMOUNT FOR THE PROJECT:

IDENTIFY ANY DEADLINES THAT IMPACT OR DRIVE THE PROJECT’S TIMELINE SUCH AS A STATUTORY REQUIREMENT, GRANT REQUIREMENT OR LEGACY TECHNOLOGY:

DOES YOUR PROJECT REQUIRE THE SUPPLIER ACCESS, PROCESS, STORE OR TRANSMIT SENSITIVE INFORMATION SUCH AS HIPAA DATA, CRIMINAL JUSTICE INFORMTION, FEDERAL TAX INFORMATION, STUDENT INFORMATION? IF SO, WHAT TYPE OF SENSITIVE INFORMATION?

Last Modified on Jul 09, 2021