OPRAH Service Request Organization Name* Contact Name* First Last Position* Executive Director Board Chair / President Phone*Email* LHIN*CentralCentral EastChamplainToronto CentralWaterloo WellingtonHamilton Niagara Haldimand BrantErie St. ClairMississauga-HaltonSouth WestNorth Simcoe MuskokaSouth EastNorth EastNorth WestAre you an OAN Member or Affiliate?* Member Affiliate Does your agency have a Union?* Yes No City* Issue urgency* Urgent/expedite (same day) Time sensitive (within 2 business days) Issue summary*OPRAH and OODPFrom time to time, the OAN OPRAH program and the Ontario Organizational Development Program (OODP) are working with the same organization to address a similar or complimentary issue. In these situations, it would be beneficial for both programs (OPRAH and OODP) to share relevant information about the issue to enable the programs to better support and serve the organization.Is your organization using support from the OODP?* Currently In the past six months In the next six months None of the Above Do you authorize the OPRAH program and the OODP to share information about your organization that is relevant to this consult?* Yes No Please explain the focus of the work with OODP*Please note that this information is collected to help coordinate and schedule your request and to avoid duplication of services. Do not disclose confidential information here.