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1. Name

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2. Workshop/Conference Title & Location

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3. Workshop/Conference Date

Format - Month/Day/Year

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4. Sponsored by

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5. Overall Conference Rating (1-Poor, 5-Excellent)

  1 2 3 4 5
Rating

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6. This professional development opportunity met my expectations:

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7. Summary of Workshop/Conference Highlights

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8. I will share information acquired at this conference with the following group(s) and/or individual(s) using the following strategies: (i.e., written summary, discussion, presentation, other--please specify.)

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9. As a result of this workshop/conference, I recommend the following changes in practice.

T