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* 1. I would like to participate in the UTCSP-IPC and understand its commitments

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* 2. I have facilitated in the UTCSP-IPC before

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* 3. Last Name

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* 4. First Name

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* 5. Profession

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* 6. Degrees

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* 7. Practice Site

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* 8. Title/Position at the University of Toronto

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* 9. E-mail Address

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* 10. Office Telephone/Voicemail

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* 11. Would you like to be considered for a “lead” facilitator role this year (students will be in groups of 30, with 2 or 3 facilitators—one designated as “lead”)?

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* 12. UTOR-ID number for BlackBoard and online library access

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* 13. Facilitator Training Workshop/Session

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* 14. Please let us know if you have any dietary restrictions

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* 15. Comments

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