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* 1. Name

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* 2. Titles (e.g. PhD, MSW, LICSW)

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* 3. Pronouns

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* 4. Are you a current MFP fellow?

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* 5. Email
(your email will be used for MFP staff to follow-up with you)

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* 6. Position Title

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* 7. University / Organization / Internship

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* 8. Link to professional webpage to share with the MFP community (e.g., university bio webpage; LinkedIn; etc.)

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* 9. Current project, publication, or achievement you wish to be highlighted (4-7 concise sentences) *please include any website links you make reference to here and write out any abbreviations.

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* 10. How does your current role impact the mental health / substance abuse needs of underserved populations? (1-2 sentences)

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* 11. How has your MFP experience impacted your career thus far? (1-2 sentences)

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* 12. Are you currently receiving the monthly MFP Connect newsletter?

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* 13. Headshot (Please attach a high-quality jpg or png image)

JPEG, JPG, PNG file types only.
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Please be aware that the information submitted in this form will be shared in the monthly MFP newsletter which is posted on the CSWE MFP website.
Thank you for your submission; your information will be sent to a member of CSWE MFP.
Please contact sdaneshmand@cswe.org for any feedback.

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