Community Leadership Program Application
Applicant Information
Applicant Name *
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Pronouns *
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Date of Birth *
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Gender (optional)
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Race/Ethnicity (optional)
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Phone Number *
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Mailing Address
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Email Address *
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Have you participated in a LYRIC program before? *
LYRIC is committed to accessibility in our programs. If you have any access needs or requests, please describe them below. We will do our best to accommodate.
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Do you have any dietary restrictions? If so, please explain below.
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What kinds of food would you like to see served at Group Meetings?
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