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First Name

Last Name

Phone

Organization

Training and Approximate Date Attended

Have you received funding since the training?

yes

Please indicate, on a scale of 1-5, how little or how much of this funding success after the workshop you attribute to your participation in our training.

1 = "very little" and 5 = "very much"

How did the training help you create change in your community?

Please add any additional comments.

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