Any agency that plans to submit an application for the Adolescent Pregnancy Prevention Program (APPP) is strongly encouraged to register its intent by 5:00 p.m. on October 21, 2022.

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* 1. Full legal name of agency:

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* 2. Mailing address of agency:

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* 3. County:

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* 4. Name of lead agency administrator:

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* 5. Contact information for lead agency administrator

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