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* 1. What is your name?

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* 3. Are you a CRC? If yes, please provide your CRC customer ID number.

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* 4. Where are you located?

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* 5. Are you currently a graduate student?

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* 6. What is your master's degree in?

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* 7. Where did you earn your master's degree?

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* 8. When did you graduate from your master's program (or anticipated graduation date)?

Date

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* 9. What is your undergraduate degree in?

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* 10. Where did you earn your undergraduate degree?

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* 11. What is your current practice setting? Select all that apply.

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* 12. What areas in the rehabilitation counseling profession would you like to discuss within the Emerging Leaders Network (i.e. challenges, strengths, etc.)

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* 13. What topics of advocacy are you interested in? Select all that apply.

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* 14. What topics would you like to explore within the Emerging Leaders Network? Select all that apply.

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* 15. Are you interested in a leadership role within the Emerging Leaders Network?

T