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Tier 2 Agency Quarterly Report Form
Today's Date
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Quarter
Agency Name *
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Person completing report
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Email of person completing report *
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Estimated Number of Households served this quarter *
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Estimated Number of Adults served this quarter (If this number is something that has not been tracked leave answer blank)
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Estimated Number of Children served this quarter (If this number is something that has not been tracked leave answer blank)
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Estimated Number of Seniors served this quarter (If this number is something that has not been tracked leave answer blank)
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Estimated Number of Total Individuals served this quarter (If this number is something that has not been tracked leave answer blank)
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Estimated Number of Hot Meals served this quarter (If this number is something that has not been tracked leave answer blank)
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