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