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  • Contact Information

  • Not sure your ZIP code +4? Find it here on the USPS.com website.

  • Student Demographics & Program Information

  • Please share the staff demographics.

  • On what days and during what times do you operate?

  • When does your program provide programming? (Please check all that apply)

  • Please indicate what services are provided by your organization by checking the appropriate boxes.
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  • Professional Development & Training

  • Funding & Sustainability

  • * Drop In Enrichment program is a program that offers additional services to children enrolled in an afterschool/summer camp and/or offers services to children standing alone from a program. For example: Boys/Girls Scouts, Girls on the Run, Karate, Dance.
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  • This field is for validation purposes and should be left unchanged.
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