Complete this form to be included in CaCN
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Name (First and Last): *
High School/College and District: *
City: *
Contact Number: *
Email Address: *
Position: *
Area(s) of responsibility: *
Please describe your experience in the field: *
Interest/Experience: *
Required
Is there an area of  particular interest or skill that you would be able to share with others?  If so, please describe:
 Please share your interest in joining the CaCN:
How would you like to be engaged in CaCN?
1. Online Facilitor: Engages the online community and contributes to the development of the counselor network. 2. Resourse Practitioner: Provides helpful and relevant resources to others in the network, on a regular basis. 3. Member: Interested in following and contributing to the activities of the network. 4. Faculty Liaison: Supports working group objectives and acts as the line of communication between CaCN and faculty. 5. Partner: CaCN supporter from a partner institution.
Clear selection
Would you be interested in connecting with others in the CaCN online community? If so, please select which platforms you prefer.
Can we add your name, title, and email address to a directory to share with the network? *
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