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* 1. Name:

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* 2. Email:

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* 3. Preferred phone number:

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* 4. Credit union organization:

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* 5. Year you completed the US DE Program:

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* 6. This DE Scholarship is to fund your Workshop registration only. Are you or your organization able to fund travel?

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* 7. Please tell the selection committee in a few paragraphs why you would like to attend the Workshop?

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