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* 1. As the individual submitting feedback, please share the following 

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* 2. Would you like to be contacted with any follow up?

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* 3. Please tell us about the group of people that participated in the discussion in the comment boxes below (include yourself): please skip if just yourself

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* 4. Which zip codes were represented in your group discussion?

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* 5. If your notes from a group discussion please identify in the comment box below how group discussion participants identified themselves as a leader by giving as the total for each category (please include yourself):

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* 6. What are the main recommendtions that came out of this discussion?

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* 7. Please upload your Demographic Information Sheet

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* 8. If you cannot upload your Demographic Information Sheet, please list the information below.

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* 9. Please upload all Notes from your discussion.

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* 10. How did you hear about this opportunity?

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* 11. Additional comments or feedback from your group discussion, experience, etc. that was not captured above.

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* 12. Please upload any additional documents. 

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