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T NAME FIRST NAME MI STREET ADDRESS CITY/STATE ZIP CAMPUS/DEPARTMENT POSITION IMMEDIATE SUPERVISOR / / LAST WORKDAY EMPLOYEE ID NUMBER This is my notice to: (check one) Resign Effective date of my resignation Retire Effective date of my retirement / / SUBJECT GRADE / / REASON Have you completed your Teacher Choice Day* requirement? Yes No N/A *The Teacher Choice Day is requirement for all Teachers and other professionals on a Teacher Work Schedule *Retirees: Unpaid supplemen.

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