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* 1. First and Last Name

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* 2. Preferred Email Address

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* 3. Phone Number

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* 4. I am applying for the:

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* 5. I am a:

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* 6. As a law student I am a:

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* 7. I am a practicing attorney with:

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* 8. Current/Last Place of Employment

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* 9. I am signing up for the Coach Program and am interested in being coached in the following areas:

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* 10. Gender

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* 11. Racial/Ethnic Minority

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* 12. I am LGBTQ

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* 13. I am Disabled

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