Agency & Facility Information 

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* 1. Name of Submitting Agency

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* 2. First and Last Name of Agency Director

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* 3. Briefly describe the agency or tribal community applying for the Facility Director/Superintendent Training (e.g., county, state, tribe).

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* 4. Indicate why the agency is interested in participating in this program. Please describe why the agency is seeking to attend the Facility Superintendent Training, what it hopes to get out of the training, and note any special challenges faced by the agency.

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