Application for Common Ground’s Community Dharma Leadership Training
Name
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Month and Year of Birth
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Address (City/State/Zip)
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Email address
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Phone number
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How do you identify your gender?
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What pronouns do you use for yourself?
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Do you identify as Queer?
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Do you identify as a person of color?
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Are you a person living with a disability?
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How do you identify your cultural / racial / ethnic heritage /ancestry/ background?
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Do you have any limitations related to physical ability, mobility or other abilities? If so, what if any accommodations do you require?
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Is there anything else you would like for us to know in reference to you and/or your identities?
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