Project L.E.A.P: Consumer Advisory Board Application

It is important that you complete all parts of the application. If your application is incomplete your application may not be accepted. If you have no information to enter in a section, please write N/A.

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Full Name (First and Last Name) *
Full Address (Street, City, State, Zip code) *
Cell Phone Number *
Email Address *
Please check if you have experience working with the following communities.  
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Required
What is your age?
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What is your current gender identity? *
What sex were you assigned at birth?
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My gender pronouns are:
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Please specify your race.
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What is the highest degree or level of education you have completed?
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Name the Agencies you have worked with or are affiliated with? *
How long did you work with the agencies? List Start and End Dates for each agency. *
Why do you want to participate in the Consumer Advisory Board?
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Are you available to meet on a monthly basis?
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What is your Meeting Preference?
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CAB members will receive an honorarium for their participation.  A $100.00 stipend will be provided after each CAB meeting via CashApp.  Do you agree to receive your stipend via CashApp? *
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