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NAME OF ENDORSEE:                     ___________________________________________________________
 

NAME OF CAPPIES PROGRAM:      ___________________________________________________________
 

TITLE OF ENDORSEE’S PROPOSED POSITION (circle one):                CHAIR             PROGRAM DIRECTOR

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NAME OF ENDORSER:                     ___________________________________________________________
 

ENDORSER’S CURRENT PLACE OF EMPLOYMENT: ____________________________________________
 

ENDORSEE’S CURRENT POSITION: __________________________________________________________
 

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