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T: 2. Donor: Amount: 3. Donor: Amount: 4. Donor: Amount: 5. Donor: Amount: What percentage of your program budget is allocated to overhead? CR 051611 Page 4 of 6 EXECUTIVE SUMMARY (one page only) Request Amount: Date of Grant Application: Name of organization (as stated on 501(c)(3) letter): Name of program/project/event: City, State where organization is located: Year your organization was established as a 501(c)(3): Is your organization a United Way member agency? Annual organiz.

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