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Juneteenth Application Form
Δ
Application Form
Name of Organization
(Required)
Organization Main Contact Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Ã…land Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
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Côte d'Ivoire
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Cuba
Curaçao
Cyprus
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Denmark
Djibouti
Dominica
Dominican Republic
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Equatorial Guinea
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Eswatini
Ethiopia
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Indonesia
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Iraq
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Kenya
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Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
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Lao People's Democratic Republic
Latvia
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Lesotho
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Libya
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Malaysia
Maldives
Mali
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Mayotte
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Panama
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Pitcairn
Poland
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Saint Helena, Ascension and Tristan da Cunha
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Virgin Islands, U.S.
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Country
Are you Safe Play approved?
(Required)
Yes
No
To be approved, this event must:
take place during June 2025
include at least 15 participants
demonstrate commitment to diversity and inclusion
incorporate history of Juneteenth
Proposed Date of the Event
(Required)
Please describe your event and what makes it so special. Include the following information:
Facility hosting the event
Target Audience
How you plan to market the event. (social media, flyers, emails, etc.)
How will this event make an impact in your community?
What are you doing to showcase diversity in this event
How the money will be used?
Please Answer the Questions above and Describe your Event in Detail
(Required)