Any agency that plans to submit an application for the MCH Initiative RFA A320 is required to submit a notice of intent no later than 5:00 p.m. on Friday, February 5, 2016. Please complete all of the information below. Confirmation of receipt will be provided in response. Agencies that do not submit a notice of intent by the deadline shall not be eligible to respond to this RFA.

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* 1. Legal Name of Agency

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* 2. Person who will coordinate the application submission

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