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<br /> GRANT REQUEST SUMMARY <br /> <br /> ORGANIZATION'S NAME: YEAR FORMED <br /> <br /> ADDRESS: <br /> Street City Zip <br /> CONTACT PERSON: TITLE: <br /> TELEPHONE: FAX: <br /> E?v4AII,: WEBSITE: <br /> NO E-MAIL ADDRESS AT THIS TIME <br /> BRIEFLY DESCRIBE THE PROJECT: <br /> AMOUNT REQUESTED: <br /> TOTA1 PROJECT COST: <br /> Il\~FORILIATION ABOUT APPLICANT <br /> 1. What is the region served (town target area, etc.): <br /> Z. Fiease provide your mission statement: (or attach a copy). <br /> 3. a. Are you currently offering spay/neuter services? <br /> (if "no sk7y !o . below) <br /> b. If yes, for how long have they been offered? <br /> a If yes, for whom? {please check all that apply): <br /> Homeless/shelter cats Homeless/shelter dogs <br /> "Owned" cats "Owned" dogs <br /> Feral cats <br /> Other (please describe) <br /> 4. a. Do you operate a shelter or rescue program? <br /> b. If yes, please describe services (use add;riona7sTaeetofynper;fnecessmy): <br /> 3 <br /> <br />