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Get Ct Coaching License 2012-2024

10-149 C.G.S. 10-149b Regs. 10-145d-424 www.ct.gov/sde APPLICATION FOR TEMPORARY EMERGENCY COACHING PERMIT PART I: PERSONAL INFORMATION (Print all information in dark ink and in uppercase letters.) LAST NAME FIRST NAME MI GENDER (M/F) BIRTH DATE (Month-Day-Year) Required SOCIAL SECURITY NUMBER ADDRESS (Street) (Apt #) (City) (State) PHONE FORMER LAST NAME(S) (Zip Code) Race/Ethnicity (Optional) (Home/Cell.

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