Advertising Request

A lot of information goes into creating a good advertising strategy! By filling out the form below, you will help the Development & Communications team make strategic decisions about when, where and how to best advertise your program and help your department meet their goals.

Someone from Communications & Development will contact you to discuss your advertising request in the coming days. If you have any questions in the meantime, please direct them to Nikki Bomasuto at Nikki.Bomasuto@accesscny.org.

Please note that submitting this form is not a guarantee. All requests are subject to the discretion of the Development, Communications & Advocacy Department.

"*" indicates required fields

Contact Information

Your Name*

First Last

Your Department*

Phone*

Email*

Program/Department Goals

What program/department/etc. do you want to advertise?*

What are the three most important things for people to know about the program/department?*

What are you hoping to accomplish with this advertising? For example, "I want to educate my referral sources on our services."*

What is your advertising budget?

Audience Information

What audience are we trying to reach?*

This can include reaching individuals directly (via social media for example) and/or reaching referral sources such as doctors offices and case managers. Information about age, location, interests (if important), can also be helpful.

Who/what are your main referral sources currently?*

Is there anything else we should know?

This field is for validation purposes and should be left unchanged.

Advertising Request

Contact Information

Program/Department Goals

Audience Information

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