*1.First and Last Name(Required.)

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

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

*4.What is your current position title?(Required.)

*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?(Required.)

*6.Are you currently a member of NTEU?(Required.)