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41 Cfr 101 44 207 Form
Address)
Telephone#
II.
Fax#
E-Mail Address
APPLICANT STATUS (Check One):
( ) Public Agency (incl. Public School Districts)
III.
( ) Nonprofit, Tax Exempt Organization
TYPE OR PURPOSE OF ORGANIZATION:
(
(
(
(
(
(
(
)
)
)
)
)
)
)
State
County
City
Museum
Library
Radio/TV Station
Other (specify)
(
(
(
(
(
(
)
)
)
)
)
)
Child Care Center
Preschool
School District
Elementary School
Secondary School
College or Univ.
( ) School for Students
with Disabilities
( ) Hospital
( ) Medical...
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