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* 1. What is your full name? (First and last)

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* 2. What is your email address?

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* 3. If you are a teacher, what school district (or college) do you work in? (Include School Name and USD #)

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* 4. Primary Phone Number:

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* 5. What position do you currently serve?

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* 6. If you are a teacher, what subject(s) do you teach?

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