Request for Invitation – 2020

Agency Contact Information-must complete all fields

Agency Name

EIN# or NGO#

Complete Address
City, State, Country, Postal Code

Contact Name

Title

Phone Number

Email

Agency Description

Services Provided to Community - please list:

Population Served:

Geographic Area of Service Delivery:

Program Specific

Please select type of HIV/AIDS program:

AdvocacyDirect care servicesPrevention

Description of program or project:

Approximate number of people who will be served:

How often services will be provided:

Agency’s annual budget:

Required documents

Please Attach Your IRS 501(C)3 Letter (max 4MB)