Law Enforcement Grant Request 
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Name
Contact information: phone, email
Agency
Is this request for personal or professional use? 
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Please give an explanation of what the funds will be used for.
Amount requested *
Is this request for reimbursement or payment?
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What date are funds needed by?
MM
/
DD
/
YYYY
I understand that a receipt for use of funds has to be provided to FCLEF board within 30 days of fund dispersal
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Submit
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