Fellows Program ~ Organizations

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Job Title

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* 5. Organization

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* 6. What is the project you are interested in proposing to us? What is the deliverable you are looking for (memo, public-facing report, blog post, helpline or clinic staffing, etc.)?

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* 7. What supervision would you or your organization be able to provide?

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* 8. What is the timeline for working on this project? Please provide the deadline, if applicable, the time commitment per week, etc.

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* 9. What questions do you have for us?

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* 10. Is there anything else we should know?