Form to be completed by AMRRIC staff.

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* 1. Program/Project Name e.g. Lajamanu vet visit, Gapuwiyak cat education, Tiwi census etc

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* 2. Start date

Date

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* 3. End date

Date

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* 4. Program Funder(s)

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* 5. Purpose

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* 6. Total number of team members

1 10 20

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* 7. AMRRIC staff in attendance

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* 8. Other team members i.e. people from outside of the community who are travelling to participate in the program
[Always include the semicolon separator in your answer.  If any of  the fields are unknown, leave a space, followed by a semicolon, e.g. if participant has no affiliated organisation or contacts, enter " ; Joe Smith; M; Unspecified; 12; "]

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* 9. Community-based team members (i.e. people from within the community) who are assisting in the delivery of the program
[Always include the semicolon separator in your answer. If any of the fields are unknown, leave a space, followed by a semicolon, e.g. if participant has no affiliated organisation or contacts, enter " ; Joe Smith; M; Unspecified; 12; "]

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* 10. Community individuals/groups engaged i.e. those people/groups within the community that are recipients of the program [Always include the semicolon separator in your answer, e.g. if participant has no affiliated organisation or contacts, enter " ; Joe Smith; "]