Information Collection Survey
RequiredRequired Question(s)
Progress: 
 
Thank you for participating in the information collection efforts to design the nations first public safety broadband network. The information collected will be provided to the FirstNetNC team for use in the consulation process with FirstNet
 
1.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:
Department:

Required 2.

Select your agency type:

Federal
State
Local
County
Tribal
Private Corporation
Public utilities
Public Healthcare
Other  
Required 3.
Enter the discipline that best describes your agency or division from the following: 
 

50 characters left.