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Name:
Last 4 of SSN:
Email Address:
Home
Work
Secondary Email Address:
Home
Work
Mailing Address:
City:
State:
Zip Code:
Primary Phone Number:
Home
Work
Cell
Secondary Phone Number:
Home
Work
Cell
Best Time to Call:
School District Name:
Position:
Teacher
Student Teacher
Substitute
ESP
Retired
Higher Ed.
Administrator
Other
Staff Attorney
Organizational Consultant
Associate Staff
Information Technology
Work Site Name:
Years in District:
Category:
Become a Member
Employment Inquiry
General Inquiry
Non-Employment Inquiry
Member Benefits Inquiry
Certification Inquiry
Fingerprint Clearance Card Inquiry
Sub Category:
Is there a Deadline or Meeting Related to your Inquiry?:
No
Yes
Unknown
Deadline or Meeting Date and Time:
Under Investigation:
No
Yes
Unknown
Not Applicable
Current Status:
Working
Assigned to Home
Other
Have you contacted your local association?:
No
Yes
If Yes, Who did you contact?:
Are you calling on behalf of another member in your local?:
No
Yes
If Yes, what is the name of the member you are calling about?:
Web Site:
http://
Subject:
Requires additional work:
No
Yes
Staff Names for Additional Work::
Level of Involvement:
Brief Advice
Extended Advice
Document Review
Document Revision
Negotiated Agreement
Refer to Local
Refer to O.C.
Refer to Outside Attorney
Description:
Attach File:
Emergency:
This is an emergency