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Please COMPLETE this form No later than March 4, 2014, and FAX to 18775957309 Conflict of Interest and Confidentiality Certification REPRESENTATION OF ABSENCE OF CONFLICT OF INTEREST Based on the

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Review bnameb - grantreviewinfonet is a form used to provide feedback and evaluation on grant applications or projects.

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Information such as project goals, outcomes, challenges faced, and recommendations for future improvement must be reported on review bnameb - grantreviewinfonet.