Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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Community & Economic Development

Options:

Consumer Education

Transportation Services

Community Improvement

Regional/State/City

Planning

Social Services Planning/Delivery

Tax Counseling

Cooperatives/Credit Unions

Micro – Enterprise

Community – Based Volunteer Programs

Thrift Store

Job Development/Placement

Management Consulting

Technology Access

Welfare to Work

Food Production/Community Gardens/Farming Small/Minority Business

Other Community Development

Other

Environmental

Options:

Waste Reduction/Management/Recycling

Clean Air

Clean & Safe Water

Energy Conservation

Indoor Environment

Toxic Waste Management

Wildlife, Land, Vegetation Protection/Restoration

Community Restoration/Clean up

Other Environment

Education

Options:

Tutoring & Child Literacy - High School

ESL

Job Preparedness/Vocation Education

Library Services

Cultural Heritage

GED/Dropouts

Head Start/School Preparedness

GED/Dropouts

Service Learning

Adult Education & Literacy

After School Programs

America Reads

Computer Literacy

Youth Leadership/Development

Other Education