United Way of Clallam County COVID-19 Crisis Fund Application
Email address *
Name of Organization *
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Please provide your EIN # (if not a United Way Partner Agency):
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Person Submitting Request: *
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Agency Address: *
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Phone #: *
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Website (if applicable)
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Today's Date: *
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Date Funding Needed By: *
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Request Amount: $ *
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Please state the nature of the request. How will United Way Funds be used? *
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