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Endowment Distribution Request
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Required
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First Name
*
Last Name
*
Address Line 1
*
Address Line 2
City
*
State
*
--
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
FM
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MH
MI
MN
MS
MO
MP
MT
NE
NV
NH
NJ
NM
NY
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ND
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VI
VT
VA
WA
WV
WI
WY
ZIP Code
*
Email Address
*
Phone Number
*
(
)
-
ext.
Amount you are requesting:
*
Brief description of your request:
*
You can email documents, photos, examples, etc if necessary to fully explain project to parkway@parkwaypc.org
If the Distribution committee can/does not recommend the full amount, can you accomplish your goals with an amount less than your request?
Yes
No
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