2017 Leader Ship Application
Organization Information
Organization Name:
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Street Address, City, State, Zip Code:
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Phone Number:
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Executive Director/Principal:
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Primary Contact Person
Name:
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Title:
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Best Contact Phone Number:
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Email:
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Person Signing Agreement
Name:
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Person Signing Letter of Recommendation
Name:
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Group Demographics
What ages of participants will be attending the program?
Required
How many participants do you anticipate? If you are not completely sure, put the highest number of participants expected.
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How many participants are English language learners?
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How many participants are in Vermont through the Vermont Refugee Resettlement Program?
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Number of male participants?
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Number of female participants?
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How many participants identify as white?
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How many participants identify as Latino/Latina?
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How many participants identify as Black/African American?
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How many participants identify as Native America?
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How many participants identify as Asian American or Asian?
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How many participants identify as Bi-racial/mixed?
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How many participants identify as other?
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How many participants live in a single-parent household?
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Additional Group Background
What concerns do participants have about sailing?
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Do any students in your group require specific accommodations?
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What goals do you have for your group?
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Any suggestions for the CSC instructors?
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