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Numerica Charitable Fund Application

 

Organization Information

Funding Request

Indicate area(s) which will benefit most from donations:

Required Supplemental Information

You must use the provided Budget Template

Non-Discrimination Disclosure

I certify this organization does not unlawfully discriminate with regard to employees, volunteers, delivery of programs or services, or clients served based on age, sex, religion/creed, race, color, national or ethnic origin, sexual orientation, gender identity or expression, disability, martial status, military or veteran status, pregnancy or genetic information.

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January 16, 2019

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