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RPA Applicants (State, local, tribal governments, and certain non-profit) NOT local Police and Fire

2. Notice
   Do not include any sensitive information on this form or (if applicable) files uploaded to this form. Sensitive information includes, but is not limited to, social security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, or passwords.
4. Organization Name*
   e.g. "Bainbridge Township"
6. Organization Type*
   -- Select One --City or Township GovernmentCounty GovernmentIndependent School DistrictIndian / Native American Tribal Government (Federally Recognized)Indian / Native American Tribally Designated OrganizationNonprofit with 501C3 IRS StatusNonprofit without 501C3 IRS StatusOtherPublic / Indian Housing AuthorityPublic/State Controlled Institution of Higher EducationRegional Government OrganizationSpecial District GovernmentState GovernmentU.S. Territory or Possession

   please select from the list
8. Contact First Name*
10. Contact Last Name*
12. Contact Email*
14. Contact Phone*
    e.g. (555) 555-5555
Leave This Blank:


16. Submit

* indicates a required field