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* 1. Himdag Committe Chair or representative Name

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* 2. Date of Review

Date

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* 3. Which Type of Curriculum

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* 4. Title of Curriculum Request

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* 5. Results of Review

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* 6. If curriculum was denied by Himdag committee, please provide reason?

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* 7. Himdag Committee consensus results.

  1 2 3 4 5 6 7 8 9 10 11 12
Number of members who voted "Yes"
Number of members who voted "No"
Number of members who "abstained"

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* 8. Upload clean copy of curriculum

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

T