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First Name

What is your organization's current legal entity status?

Do you have a formal fiscal sponsor that holds active 501(c)(3) status?

Yes

Where is your organization primarily registered and operating? (State/Territory)

What is the primary focus area of your organization's mission?

If you checked Cooperative Economics or Mutual Aid: Does your initiative utilize a worker-owned, patient-owned, or community-governed operational framework?

What was your organization's total operating budget for the last complete fiscal year?

SelectRoughly how many employees are currently on your baseline payroll?

Has your organization successfully managed or received any formal grants in the past 3 years?

Yes

Please list up to 3 of your most recent grant achievements (Funder Name, Operational Purpose, and Award Amount):

Which service interests you the most?

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