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* 1. How did you hear about me?

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* 2. What best describes your situation (check all that apply)

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* 3. If you are a student looking for practicum placement, please upload a coverletter and updated resume. 

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* 4. I am currently operating a wait list. If an opportunity comes up how can I contact you?

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* 5. What is your preferred contact method?

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* 6. Do you have anything else you'd like me to know?

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