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POLITICAL & CORPORATE ADVISOR
PSYCHOLOGIST
Directions:
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This form must be completed by the office of the Philanthropy Referral Partner*.
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To receive the funds, an active U.S. bank account is required.
To ensure validity of financial need, unsolicited requests for funding cannot be accepted.
* Philanthropy Referral Partners are political or corporate leaders who, due to legislation or other restrictions, are prevented from giving direct financial support to private citizens.
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