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Te Section II and submit to: WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION EDUCATOR LICENSING P.O. BOX 7841 MADISON, WI 53707-7841 Telephone: (608) 266-1028 I. APPLICANT INFORMATION Complete and Forward To Institution Legal Name First Middle Int. Social Security No.* Last 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 t.

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