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Learning Communities Interest Form

Please provide the following information so that we can define the demographic of each Learning Community.
Name
Email
Telephone
  
*
Academic Rank
*
Department
*
School or College
*
Select the Learning Community (LC) in which you are interested.
*
Briefly describe your reasons for wanting to participate in this LC.
*
What do you think you can contribute to the program? (Note: Learners new to the topic are welcome.)
Please indicate anything else you wish to share regarding your possible involvement in this program.
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