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Get HI HTSB LA 3009 2017-2024

N Complete and sign Section 1 before sending this form to the administrator of your educator preparation program. Ask your program to return this form to HTSB at the address indicated at the top of this form. Forms can also be emailed or faxed. 1. PERSONAL INFORMATION. Type or print in blue ink. Last 4 digits of Social Security Number XXX - XX - _____ _____ _____ _____ Date of Birth: _____/_____/___________ Phone (Last name) Current Mailing Address Non Lotus Notes E-mail Address (First name).

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