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DISSCHOLARED Consulting Request Form
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Name (First, Last Name)
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Your answer
Email Address
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Your answer
Email Address
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Your answer
Phone Number
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Your answer
Company/Organization
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Your answer
Website
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Your answer
Consulting Request
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DISSCHOLARED Gray Package
DISSCHOLARED Green Package
Speaker
Panelist
Workshop
Other:
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Business Operating Budget (Only include monetary only, please do not include in-kind)
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How many students will this project support?
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Any additional questions?
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