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Coaching Essentials Registration
May 23-24, 2018
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IN ORDER TO ENSURE THAT OUR PROGRAMS ARE EQUITABLE AND INCLUSIVE, WE WOULD LIKE TO ENLIST YOUR COLLABORATION BY RESPONDING TO A FEW QUESTIONS ABOUT YOURSELF.  YOUR ANSWERS WILL HELP US EVALUATE OUR SERVICES THROUGH THE LENS OF EQUITY AND INCLUSION.  AND, PLEASE DON'T HESITATE TO REACH OUT TO US SHOULD YOU HAVE ANY QUESTIONS ABOUT THIS PRACTICE.


NAME *
ORGANIZATION *
SECTOR *
TITLE/POSITION *
EMAIL *
RACE *
ETHNICITY *
GENDER/GENDER IDENTITY *
SEXUAL ORIENTATION *
DISABILITY *
DISABILITY-RELATED ACCOMMODATIONS
*Someone will follow-up to talk with you about your request
Will you need material in alternate formats?
If so, what kind?  Any other needs?
SCHOLARSHIP REQUIRED *
*The CDI will contact you regarding scholarship opportunities
PLEASE INDICATE ANY DIETARY NEEDS
PAYMENT OPTIONS *
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