COMMITMENT TO CHANGE FORM



Name

Program

Position

Contact Address

City

State

Zip

Phone(day)

(evening)

List about three key changes in your practice you would like to accomplish as a result of participating in the Training Institute. The changes that you identify should be a) very specific, b) very important to you, and c) you should feel very confident in being able to bring about these changes. Do not list changes that are vague or unimportant to you. Please include this form in the envelope to be returned to NISAL after the workshop. Thank-you.
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