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* 1. Your name

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* 2. Organization or School District Name

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* 3. Organization Type

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* 4. Organization Address

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* 5. Phone Number

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* 7. Estimated number of trainers who will complete the T4T

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* 8. Geographic service area that you plan to provide this program (county, region, statewide, etc.)

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* 9. How your organization plans to deliver ETS-Y (classroom, youth groups, after school, community workshops, other)

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* 10. Anticipated program launch timeframe

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* 11. I confirm that our organization intends to move forward with the ETS-Y Train the Trainer licensing process

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