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* 1. I currently am a (select all that apply)

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* 2. Of the items below, please identify UP TO FOUR you think MUST be incorporated into a Ford Institute Leadership Program curriculum rewrite if we are to consider it a success.

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* 3. OPTIONAL: I am excited to share more ideas to help reshape the leadership curriculum in the following ways (check all that apply)

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* 4. OPTIONAL: If you answered yes to question 3 above, please share your name and email.

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