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II - Instructor Information Review Table Table is to be completed by the Academic Instructor Name 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. REVISED 01/01/2016 License Type(s) License Number(s) Date of Hire Total Continuing Education Hours & Year Earned CE in Teaching Methodology Hours & Year Earned Date Performance Evaluation Completed.

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