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* 1. Last Name

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* 2. First Name

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* 3. School or Organization

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* 4. Job Title

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* 5. Email Address

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* 6. Mobile Phone Number

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* 7. GaPSC Certification Identification Number

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* 8. In 500 words or less, explain why you are interested in joining the next Charter School Leadership Center cohort. Specifically, what challenges and successes have you experienced in your current role?

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