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Type or print in ink. Make checks payable to Treasurer of Virginia. Virginia Department of Education Division of Teacher Education and Licensure P. The renewal fee is 25. A 50 fee is assessed for a returned check. Part I-INFORMATION Last Name First Name PLEASE PRINT OR TYPE Middle Name Home Address Date of Birth City State Daytime Telephone Number include area code Home Telephone Number include area code Endorsement s License No. or Social Security No. Zip Code Highest Degree Earned Renewal...
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