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- Did you submit the proposal form prior to conducting the activity?*
- Does this activity require reimbursement? (Select Yes if you need funds reimbursed, or No if no reimbursement is required.)*
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- Project (PICK ONLY ONE OPTION)*
- Project Type (PICK ONLY ONE OPTION)*
- Project Category*
- Project Scope*
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- Project Area*
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- If your activity was a Screening/Blood Donation/Medical Camp, please mention the number of HEP B/HEP C and HIV positive patients*
- Start Time*
- End Time*
- Activity Start Date*
- Activity End Date
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- Program Flow*
- Expense Breakdown (mention only the items and amounts that need to be reimbursed)*
- Write the item and its total cost in the right category. Example: gloves 1290, posters 500. One line per item. Only listed items will be reimbursed.*
- Sponsorship Details (if none, then type NIL)*
- Expense Breakdown (Donations/Partners) (if non, then type NIL)*
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