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* 1. Name:

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* 2. Title:

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* 3. Agency:

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* 4. Email Address:

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* 5. How many years have you been facilitating or presenting?

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* 6. What is the primary audience you are facilitating and presenting to?

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* 7. After attending The Instructor Skills Training class, how will you utilize and apply your new skills?

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* 8. Has your supervisor approved you to attend this course?

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