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Get Apleyment Name Online From Form

NT NAME (Print or Type): SSN: MAILING ADDRESS: EMAIL: PHONE: NO, I did not provide eligible teaching service for the 2012-13 school year. Please explain below: YES, I provided eligible full-time teaching service in my designated area for the 2012-13 school year at the following school: Full School Name ASAM School? Circle Yes or No County School District I hereby authorize a school official to complete and release the information below to qualify me for APLE benefits. (Submit to your.

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