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Organization Name <br />Address Line 1 <br />Address Line 2 <br />City State Zip Code <br />State of Minnesota Non-Profit Registration Number <br />Person responsible for grant <br />Email <br />Phone <br />Please describe the purpose/mission of your non-profit: <br />Please describe how your non-profit currently serve the community of Roseville. In your response <br />please include the number of Roseville community members you serve and the costs for providing your <br />services to the Roseville community: <br />Please describe the negative financial and operational impact COVID-19 has had on your organization. In <br />your response, please include specific information about the financial and operational impact <br />along with any pertinent documents demonstrating the impacts: <br />Please describe how much funds you are asking for (maximum $10,000)and how you would funds <br />awarded under this program: <br />Please indicate how much,if any,other COVID-19 relief funding your organization has received and <br />what it was used for: <br />City of Roseville <br />Non-profit Application for use of ARPA Funds <br />Attachment B