General Information

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* 1. What's the name of your organization?

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* 2. What type of organization do you work for?

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* 3. What state is your organization located in? If it is located in more than one state, please list the state where you primarily provide services.

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* 4. What city or county is your organization located in? If it is located in more than one city or county, please list the city or county where you primarily provide services.

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* 5. What is the median annual household income of clients served by your organization? Please provide your answer as a dollar amount, not as a range (e.g., $30,000). If you don’t know, write “Don’t know.”

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