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* 1. Applicant details

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* 2. What regions do you operate within? (select all that apply)

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* 3. What are the expected outcomes of your application for funding? (select all that apply).

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* 4. Describe your request for funding.

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* 5. Do you have quotes or further information related to the product, service or initiative?

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* 6. Please acknowledge each of the following statements.

 
100% of survey complete.

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