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* 1. Name

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* 2. Contact Info

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* 3. What County do you reside in

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* 4. What age group are you?

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* 5. What is your gender?

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* 6. Highest level of education you attained to date?

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* 7. Primary Reason for participating in this program?

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* 8. Are you currently working?

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* 9. If employed, which best describes your current job?

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* 10. How did you hear about this program?

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* 11. Are there any specific programs/classes you would like offered at the CEC?

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* 12. Would you like added to our email list to receive updates from the CEC?

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* 13. What Lunch with Lec Series would you like to register for?

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