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Community Organization Resource Requests
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Date of Request
Name of Requesting Facility
Address of Facility (DUPAGE COUNTY ONLY)
Point of Contact (POC) Name
POC Email Address
***PLEASE INCLUDE TOTAL COUNTS YOU WOULD LIKE TO REQUEST RATHER THAN A BOX/CASE COUNT
COVID-19 Antigen Tests
Medium Nitrile Gloves (only to be used in non-clinical setting such as food preparation or cleaning)
What population(s) do you plan to redistribute these resources to? (e.g., staff, patients/clients, etc.)
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