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* 1. Your organization's name:

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* 2. Please select the choice that best describes your organization:

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* 3. In what county do you provide services (please check all that apply)?

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* 4. Please check any of the poverty related services your organization provides (check all that apply):

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* 5. In your opinion, what are three big problems impacting families the most?

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* 6. What services are missing in your community to effectively address these issues?

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