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Name:
Address:
City
State
Zip
E-mail:
Web Site:
Contact Person:
Title:
Phone #
Amt Requested:
Name of Special Project, if any, for which Funds
are requested:
Mission:
Proposal Summary (including budget proposal):
Does the project focus on creating a social or societal change? If so, how would this project help to enlighten individuals/society?
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howe@qx.net
