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* 1. What is the name of your community?

If you had 3 wishes for your community, what would they be?

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* 2. My 1st wish....

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* 3. My 2nd wish..

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* 4. My 3rd wish....

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* 5. What is your age?

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* 6. What is your gender?

Thank you for sharing your 3 wishes. This will help inform a plan for positive action in your community.

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