Agency address (include street, city, state, zip) *
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Agency phone number *
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Agency/program website *
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What types of services does your organization provide for fathers? (Select all that apply) *
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Which county/counties does your organization primarily serve? *
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Who does your program/organization serve? (Select all that apply) *
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Please describe any eligibility criteria you use for accepting clients that would help us understand who is eligible for your services. (limit: 254 characters, including spaces) *
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Give a general summary of your fatherhood program and the services you provide. (limit: 254 characters, including spaces) *