Advisory Group Agenda Request Form
Submitted by:
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Email address
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Representing (region/caseload):
Caseload
Region
Tribal
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If caseload, select group:
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
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Region:
Northeast
Southeast
Northwest
Southwest
East Central
West Central
Metro
South Central
Southwest
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Who will lead discussion:
Submitter
Advisory Chair
Other
Please specify
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Agenda item suggestion:
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Main talking points:
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End goal of topic:
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Time requested to discuss:
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