DEEP Diabetes Education Program Peer Educator Training

JUNE 22 -29
Open Door Health Center of Illinois
157 S. Lincoln Ave.
Aurora, IL, 60505

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* 1. Full name/ Nombre Completo

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* 2. Email address/ Correo electronico

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* 3. Telephone number / Numero de telefono

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* 4. State / Estado

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* 5. Currently Employer/ Actual empleador 

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* 6. What is the highest level of education you have attained? / Cual es su grado de educacion?

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* 7. Please state the reasons or benefits that motivated you for applying for this certification. / Por favor explique las razones y/o beneficios que tiene para aplicar a esta certificacion. *

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