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* 1. Name

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* 2. Pronouns

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* 3. School at which you teach

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* 4. Please describe your school (e.g. public, private, charter, etc.)

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* 5. City and State where your school is located

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* 6. E-mail address

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* 7. Phone number (mobile preferred)

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* 8. Please describe what courses you teach and what grade level.

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* 9. Why are you interested in participating in this workshop?

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* 10. What experience do you already have with the U.S.-Japan relationship?

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* 11. How might you incorporate topics learned into your classes?

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* 12. Is there anything else you’d like to share about your interest in this program?

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* 13. If accepted, can you participate in the full zoom workshop on November 16 evening in the U.S. / November 17 morning in Japan?

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* 14. If accepted, are you willing to engage in some pre-workshop readings and post-workshop brief activities?

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* 15. If accepted, may we list your name and your school’s name as a program participant?

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* 16. If accepted, may we record your image for use in marketing materials?

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* 17. Please sign this form by entering your full name below. By signing you agree to apply for this program, that all the answers above are true to the best of your knowledge, and that we contact you via e-mail and/or phone to discuss the program.

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