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Name
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Department/Unit Affiliation
Academic Faculty
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Department Chair/Unit Leader
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Program Information
Describe one to two leadership development goals that you are interested in pursuing. For each goal, briefly explain why you are interested in this area and the benefits to your leadership development.
Identify the leadership development program you wish to participate in. Please include a brief overview of the program.
Provide a personal statement on the role diversity and inclusion plays in your leadership goals.
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