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* 1. First and Last Name

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* 2. What Center, Office, and Division do you currently work in? (Please provide the full names, avoiding acronyms.)

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* 3. What subject matter expertise or role can you contribute to the Change Leaders group?

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* 4. What is your current position title?

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* 5. Do you understand the commitment of approximately 2 hours per week to attend Change Leader meetings, and will you be able to participate at this level?

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* 6. Are you currently a member of NTEU?

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