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Required Field
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Contact Information
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Agency Name:
Agency Name is required
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Agency Contact First Name:
Agency Contact First Name is required
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Agency Contact Last Name:
Agency Contact Last Name is required
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Agency Contact Phone:
Agency Contact Phone number is required
Invalid phone number. Please enter a phone number with the format xxx-xxx-xxxx.
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Agency Contact E-mail:
Email is required
Email address is invalid.
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Please use username@agencyacronym.IN.gov
e-mail address (ex = jsmith@isdh.IN.gov).
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Website Information
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Website Description:
Website Description is required
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Intended Audience:
Intended audience is required
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Requested Completion Date:
Month is required.
Date is required.
Year is required.
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Month:
Date:
Year:
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Amount of content pages to be created:
Amount of Content pages is required
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Is this a new website or an update of an existing?
Select one
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Does the website require any logo and/or graphic creation?
Select one
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Would you like to implement GovDelivery?
Select one
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Would you like to implement Siteimprove?
Select one
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Will any Social Media tools need to be implemented?
Select one
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Will any website features require interactive functionality or database connectivity?
Select one
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