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NPIN Featured Partner Nomination Form


Nominees should be community-based, local government, or non-profit HIV/AIDS, viral hepatitis, STD, or TB prevention organizations in existence for at least three years.

Fields marked with * are required.


 
*Name:
   
(xxx-xxx-xxxx)  

Nominated Organization
(xxx-xxx-xxxx)
 
If yes, please provide:
 
(xxx-xxx-xxxx)
Please provide the names of the organization's top three funders:

Follow-up Contact at the Organization:
   

For use on the NPIN Web site, please provide below an overview of the organization and information on a particular program. Please include information that would be useful to others working in the field, such as background information on programs and services, populations served, and online resources and publications. If the organization implements any CDC recommended programs, please describe one in the “Program to Highlight” section. If not, please describe a successful program of the organization and its impact on the stakeholders. Thank you!
 

(Maximum of 1000 words.)



(Maximum of 1000 words.)


 
 
  



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