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United Way Warren County Request for Funding Survey
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* Indicates required question
Is your agency 501(c)3 designated?
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Yes
No
How long has your 501(c)3 been established?
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Your answer
Legal Name of Organization:
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Your answer
Agency Address:
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Your answer
Employer Identification Number (EIN #):
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Your answer
Are you located in Warren County and/or provide a program that serves Warren County?
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Yes
No
What is your program name?
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Your answer
Is this an agency program or collaborative with other agencies?
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Program - Your agency is the only provider of services
Collaborative - Your agency is partnering with other agencies to provide services
What would United Way of Warren County funding be used for to make your program successful?
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Your answer
Name of Executive Director:
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Your answer
Executive Director Phone Number:
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Your answer
Executive Director Email:
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Your answer
Name of person completing this survey:
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Your answer
Contact Phone Number:
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Your answer
Contact Email:
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Your answer
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