2017 Stakeholder Meeting Partner Profile

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* 1. Organization Name:

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* 2. Organization Address:

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* 3. Type of Partner:

Government Agency

Non-Profit Organization

Private Organization

Faith-based Organization

Other

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* 4. Organization Mission:

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* 5. Organization Target Audience:

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* 6. Funding Source(s):

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* 7. Current Active Partners:

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* 8. Your Name:

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* 9. Your Title:

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* 10. Your Phone Number:

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* 11. Your Email:

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* 12. What are you hoping to gain from this meeting?