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Get Pcs Packet - The State Of Connecticut Website

18 www.ct.gov/trb PRIOR CONNECTICUT TEACHING SERVICE BUY BACK REQUEST FORM Not to be used for any other type of service other than CT Teaching Service Withdrawn/Refunded (PLEASE PRINT OR TYPE) Member Information: Member Name Street Address City, State, Zip Social Security # TRB Account # Current Employer Member E-Mail Prior Connecticut Teaching Service Withdrawn Information: To the best of your knowledge, list the School District(s) where you previously taught, the dates of service and total.

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