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TPC Group Employee Information
(if completed by TPC employee)
Email
*
Phone number
Name
Employee Number
Your role (if any) in the charitable organization
TPC Location
Organizational Information
Organization Name
Federal Tax ID Number
Contact Name
Title
Contact Email
Phone number
Street address
City
State
Zip Code
Organization Mission
Civic/Community
Health and Human Services
Education
Environment
Other
Organization outreach area
Organization mission statement
Detailed Description of how Funds will be used (Include if funds will be used for a specific program/event within the organization):
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