1. Required Organizational Background Information

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* 1. Organization Name: 

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* 2. Please indicate which Hub your organization serves:

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* 3. If you serve Long Island, please indicate the area(s) you serve:

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* 4. If you serve the Hudson Region, please indicate which counties you serve:

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* 5. Address for headquarters including zip code:

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* 6. How many years has your organization operated?

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* 7. Annual number of unduplicated individuals served each year:

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* 8. Has your organization ever been cited by any government agency for a deficiency?

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* 9. What is your annual operating budget?

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* 10. In which sectors does your organization provide services? Please check all that apply.

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* 11. Name of person completing this survey:

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* 12. Contact person’s phone number:

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* 13. Contact person’s email address:

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