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Get WI PI-1612 2014-2024

V/ Forms are available at: http://tepdl.dpi.wi.gov/licensing/supplementary-forms Educator Licensing Telephone: (608) 266-1027 or (800) 266-1027 I. APPLICANT INFORMATION Complete and Forward To Institution Legal Name First Middle Int. Last Social Security No.* Home Address Street, Box, City, State, Zip Telephone Area/No. Name and Location of Institution Degree Earned Date of Graduation Mo./Year License(s) Requested II. INSTITUTIONAL ENDORSEMENT AND ASSURANCES Complete and Return to Appl.

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