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Partnership Request Form
Name of person submitting request:
Telephone of person submitting request: ()  - 
E-mail of person submitting request:
Organization Name:
Fundraising Goal: $ 
Address:
City, State, Zip Code:  
Authorized Contact Person:
Is this organization located within the
Frontier Service Area?
Is the requester affiliated with the
organization being referred?
If yes, describe the level of participation:
Justification -- Provide a brief description of the request and why
the applying organization should be considered for
the Frontier Community Connections Program:
Additional Comments: