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Evaluation Questionnaire

Grant and Contact Information

1.Enter Docket Number(Required.)
2.Enter Name of Organization(Required.)
3.Contact Information(Required.)
4.Grant Project Title(Required.)
5.Grant Project Dates(Required.)
Start Date
End Date
6.Amount Awarded (i.e., $20,000)(Required.)
7.Amount Remaining (i.e., $5,000)(Required.)
14%