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* 1. First and Last Name

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* 2. Email address

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* 3. Class Year

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* 4. Academic major(s)/minor(s)

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* 5. How do you self-identify in terms of race/ethnicity?

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* 6. How do you self-identify in terms of gender?

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* 7. Please identify the two dialogue topics in which you are most interested in participating. (Note: Final dialogue placement will be determined by interest as well as availability of peer-facilitators.)

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* 8. Please explain why you prioritized the topics you did (2-3 sentences will suffice).

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* 9. Please write a brief essay (250 words or less) explaining: (1) why you are interested in enrolling in an IGR dialogue, and (2) what you hope to gain from this experience.

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* 10. How did you hear about these inter-/intra-group dialogues on race? (select all that apply)

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