Thank you for your interest, please fill out the following application.

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* 1. Are you an organization or a community / affinity group?

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* 2. What is the name of the organization / affinity group?

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* 3. What is the city and state where your organization/ affinity group is located?

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* 4.
Please provide the contact information of the person we should be in contact with about your application? 

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* 5. Please tell us the mission/goals of your organization / affinity group.

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* 6. What are you all working on and how is this tied to your upcoming action?

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* 7. Is this a Rapid Response Action? (happening in the next few days or upcoming 2 weeks)

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* 8. What is the timeframe for your action? (ie. Nov 2019 - Jan 2020 or in the summer of 2020) Please note that applications are reviewed on a monthly basis.

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* 9. Please tell us how this scholarship will be utilized.

What is the goal of the action?

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* 10. What is the demand behind your action?

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* 11. What does this action call attention to? 

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* 12. Who is directly impacted by this issue and how are they represented in the action?

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* 13. Optional; Recipients of the ACT Scholarship can choose any of the following tools and support for their upcoming direct action. This is an add-on and will not impact the scholarship amount requested. If interested please choose from the following tools: 

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* 14. What is the overall budget of your organization / group?

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* 15. What is the overall budget for this action?

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* 16. How much in funds is your organization / group requesting?

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* 17. How will this money be used? Please provide an itemized budget using the field below.

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* 18. Who are your key decision-makers and their identities?

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* 19. Reference / Endorser #1

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* 20. Reference / Endorser #2

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* 22. Were you recommended to apply by a sister organization / community?

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* 23. Any questions for us? 

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