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Organization/Institution Name

Contact Person

Position/Title

Email Address

Phone Number

Organization/Institution Website

Organization/Institution Size (Number of Employees/Students)

Location (City, State/Province, Country)

Brief Description of Organization/Institution

What specific community-wide issues or challenges does your organization/institution face?

How do you envision partnering with Antaha to address these challenges?

What are your organization's values and principles?

What resources or support do you hope to gain from a partnership with Antaha?

Have you worked with similar organizations or initiatives in the past? If so, please provide details.

What are your priorities for this partnership?

How did you hear about Antaha?

Is there anything else you would like us to know about your organization/institution or your interest in partnering with Antaha?

Thank you for your interest. Someone from our team will reach out to you shortly!