Genesee County CDBG-CV Basic Needs Assistance Program Application

Basic Information

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* 1. Agency Name

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* 2. Agency Address

Address

Address 2

City/Town

ZIP/Postal Code

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* 3. Agency DUNS Number

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* 4. Agency Website or Social Media

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* 5. Contact Person

Name

Email Address

Phone Number

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* 6. Amount of Grant Funding Requested (up to $10,000)