Action Against Inequality Application

1 Start 2 Complete

Date of Application *

Name of Organization: *

Contact Email: *

Phone Number: *

EIN: *

Current Street Address of Organization: *

City of Organization: *

State of Organization: *

Zip Code of Organization: *

Does your organization provide services to East Providence residents?: *

YES

NO

Authorized Representative (Print): *

Authorized Representative (Signature): *

Date of Signature:

Please attach all necessary documentation required to process your application:

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx ppt pptx.

Please attach all necessary documentation required to process your application:

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx ppt pptx.

Please attach all necessary documentation required to process your application:

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx ppt pptx.

Please attach all necessary documentation required to process your application:

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx ppt pptx.

Please attach all necessary documentation required to process your application:

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png tif pdf doc docx ppt pptx.