CFAR/TRAC K Club Participant Request Form

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* 1. Name

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* 2. Email

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* 3. Topic of research plan

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* 4. Mentor Name

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* 5. Where are you currently in the process of developing your research plan?

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* 6. Preferred meeting location

In-person

Virtual

Hybrid

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* 7. My proposal is a:

New Submission

Resubmission

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* 8. Goal submission date

Date / Time

Date