WORLDVOICE CIVIL EDUCATION
Ending the
Self Damage
that Leads to
Incarceration
Community Organization Application
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Indicates required field
Name
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First
Last
Your Job Title
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Name of Organization
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Email
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Phone Number
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Type of Organization
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Your Relationship to Participants
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Venue
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Number of Computer Terminals
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Number of Facilitators
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1 to 3
4 to 10
11 or More
Number of Participants
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10 or less
11 to 25
26 to 50
51 to 100
101 or More
Will you use Volunteers?
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Will You have 8 weeks to implement?
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Comment
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Submit
