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* 1. Please give your name.

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* 2. What do you believe are your unique talents or areas of giftedness?

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* 3. If you are currently serving, in which of the following key areas do you serve? (Check all that apply.)

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* 4. If you are not currently serving but are interested in doing so, which of the following key areas might be of interest to you? (Check all that apply.)

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* 5. Would you be interested in career mentoring for juniors and seniors who are exploring your career field?

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* 6. In general, when would be the best time for you to serve?
(Check all that apply.)

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