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* 1. Program name

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* 2. City/State

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* 3. Lead contact person

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* 4. Position

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* 5. Contact person phone #

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* 6. Contact person email

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* 7. Program director

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* 8. Program director phone #

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* 9. Program director email

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* 10. Statement of need and purpose of the site visit (please be as specific as possible):

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* 11. Who will lead this process within the program?

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* 12. Will s/he be available to the consultant as needed during the visit?

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* 13. What staff will be involved?

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* 14. Preferred dates for the site visit:

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* 15. Is this visit and purpose endorsed by the program’s leadership?

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