Fiscal Agent Request Application
This application is used to request the Fayette County Family Resource Network (FRN) to be a fiscal agent.
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Organization Name *
Organization Contact (name, phone, email) *
Organization Mission *
Program Name *
Program Date(s)
Program Purpose *
Budget Amount *
Geographic Area Served *
Structure of Program (ie. paid staff, Board of Directors, etc.) *
Frequency of funds *
Reason for Fiscal Agent Request *
Other Information or Comments *
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