COVID-19 Relief Application
Agency Name and Address *
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Name of Applicant and Email *
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Phone *
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Purpose of Grant (one sentence) *
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Amount of Request (in dollars)
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Geographic Area Served
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Briefly describe the services your organization provides and explain the need for these services *
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Describe your organization's ability to maintain operations during this crisis and how additional funds will allow your organization to continue serving those in need *
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Identify the time frame of funding needed (ex: to cover 30 days of services, 60 days of services, etc) *
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How is your organization responding to the increased need or changes? *
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What specific priority population(s) is your organization serving currently? Please also identify income levels of clients served (ex: 200% FPL, ALICE, no-to-low income, etc) *
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