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* 1. Name:

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* 2. What neighborhood or organization are you representing?

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* 3. How will you and your community benefit from your participation in Neighborhood Leadership Academy?

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* 4. How much of the registration fee can you cover? Please describe the barrier to paying the full registration fee (you, your neighborhood/organization, etc.)

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* 5. What other resources in your community have you sought out for financial support to participate in the NLA?

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* 6. Email:

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* 7. Phone Number:

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