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Application Form
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To be filled out by Agency or Department
DEPARTMENT INFORMATION
*
Indicates required field
Name of agency or department
*
Volunteer Department?
*
Yes
No
Contact name
*
Telephone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Department Type
*
Government Entity
Non-Government Entity
If non-government, is your department a 501(c) (3)?
*
Yes
No
Not Applicable
ADDITIONAL INFORMATION
Percentage of personnel
paid vs. volunteer
Total number of personnel
*
Enter numeric value for total number of personnel (volunteer and paid personnel).
% Paid
*
Enter 0% if none.
% Volunteer
*
Enter 0% if none.
DESCRIPTION O
F NEED (
Not more than 300 words - attach sheets as needed)
Estimated cost of request:
*
Brief explanation of the training or equipment request:
*
Try to be specific as possible.
Attach sheets as needed.
*
Max file size: 20MB
Submit