Closings and Delays Center Application
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Institution Name: *
Institution Type: *
Street Address: *
City: *
County: *
State: *
ZIP: *
Institution Daytime Phone: *
Institution Website:
Primary Contact First Name: *
Primary Contact Last Name: *
Primary Contact Phone (after hours): *
Primary Contact Email (will receive ID/PIN and password): *
Secondary Contact First Name:
Secondary Contact Last Name:
Secondary Contact Phone (after hours):
Secondary Contact Email:
Number of students/employees: *
There is ONE MORE STEP to complete your application. Please email the support documentation to verify the number of students/employees to at your earliest convenience.  The support documentation needs to be issued by a government entity and be able to verify the number of people the organization employs or services  (e.g. daycare operations license, building permit listing maximum occupancy, workers compensation statements that show the number of covered employees, etc.). For churches, send your average weekly attendance on church letterhead. This document is REQUIRED to complete your request, and your account CANNOT be set up until we receive the verification. 
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