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* 1. Name

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* 2. Email Address

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* 3. what is your position/title?

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* 4. What college/ unit are you a member of?

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* 5. What department are you a member of?

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* 6. Please select all activities you would be interested in participating in to support and help advance Outreach and Engaged Scholarship.

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* 7. If you answered "Other" please explain

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