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* 1. First Name:

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* 2. Last Name:

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* 3. Your Email:

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* 4. Current Job Position and Workplace

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* 5. Your Home Country

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* 6. Dates of your international exchange program to Oregon

Date

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* 7. Which Exchange Program did you participate in?

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* 8. Theme of your Program

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* 9. Please share your social media with us if you would like the community to connect with you.

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* 10. Insert a link that you would like us to share about you and/or about the work you do. 

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* 11. Tell us a bit about you: Where do you work/study in school? What does being a Global Citizen look like in your life?

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* 12. What was a key takeaway from your time in Oregon, and/or how you have used the information you received here in your current work (if at all).

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* 13. Any positive message/word of advice to the readers you want to share

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* 14. Please upload a headshot of you for us to use in the Citizen Diplomacy Map

PNG, JPG, JPEG file types only.
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* 15. Please upload a photo of you, your work, or your time in Oregon for us to use in the Citizen Diplomacy Map

PNG, JPG, JPEG file types only.
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* 16. Please upload a photo of you, your work, or your time in Oregon for us to use in the Citizen Diplomacy Map

PNG, JPG, JPEG file types only.
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* 17. Please upload a photo of you, your work, or your time in Oregon for us to use in the Citizen Diplomacy Map

PNG, JPG, JPEG file types only.
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* 18. Please upload a photo of you, your work, or your time in Oregon for us to use in the Citizen Diplomacy Map

PNG, JPG, JPEG file types only.
Choose File

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