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Please read all descriptions and complete all fields.

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  • Please provide the official name of your organization.
  • List all alternative names for your organization/branch location. NOTE: Organizations with multiple branch locations must apply for each individual branch, coupons cannot be distributed between branches.
  • NOTE: Coupons are sent via fax, an updated fax number is required.
  • Please give as much detail as possible so we can better understand the families that would be using the Community Partner Free-Admission Coupons.
  • Please provide a detailed description of the coupon distribution process and your approach to monitoring appropriate use.
  • Ethnic Background of Families Served

  • Percentage
  • Percentage
  • Percentage
  • Percentage
  • Percentage
  • Percentage
  • Percentage
  • Required Documents and Authorization

  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.
  • Drop files here or
    Accepted file types: jpg, gif, png, pdf.
    If your organization has additional information on the populations you serve, the services you provide, as well as your history in the community please upload those files. This documentation will be used during the review process.