Train the Trainer: Practitioners Training

May 6-8, 2024

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* 1. What is your first and last name?

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* 2. What is your mailing address?

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* 3. What is your physical address? (If different from mailing)

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* 4. What is your email address?

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* 5. What is your phone number?

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* 6. What county do you live in?

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* 7. What is your race?

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* 8. What is your ethnicity? 

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* 9. What is your gender?

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* 10. Which describes where you live?

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* 11. What is your English proficiency status? 

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* 12. Number of adults (18+) in family?

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* 13. Total number of dependents in family (under 18)

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* 14. What is your gross annual income?

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* 15. Do you have a disability? 

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* 16. What is your marital status? 

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* 17. Are you a veteran? 

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* 18. What is your education level? 

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* 19. Employment status (Check all that apply)

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* 20. Do you have any food allergies or dietary restrictions?

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* 21. payment options

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