The purpose of this survey is to capture all of the relevant contact information for our CSBG network.

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1. Please provide only BASIC AGENCY information (more specific information will be asked in additional questions).

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2. Please indicate TYPE OF AGENCY:

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3. Please indicate all the CSD FUNDED PROGRAMS the agency administers:

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4. Please provide requested information for the EXECUTIVE DIRECTOR of the agency.

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5. Please provide requested information for the CSBG PROGRAM MANAGER of the agency.

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6. If you have more than one CSBG PROGRAM MANAGER, please provide their information here.

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7. Please provide requested information for the CHIEF FISCAL OFFICER (or equivalent) of the agency.

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8. Does the agency have a CSBG ARRA PROGRAM MANAGER, different from your regular CSBG program manager, that CSD should be aware of for proper communication? If so, provide the contact information below.

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9. Does the agency have OTHER CONTACT INDIVIDUALS or INFORMATION that CSD should be aware of for proper communication? If so, provide the information below.

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