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W. Seneca NY 14224 FAX 716-821-7498 NAME POSITION/GRADE LEVEL DISTRICT SCHOOL BLDG. NEED CTLE CERTIFICATE IF SO PROVIDE MONTH DAY OF DOB OPTIONAL CTLE INFO. 00/per participant CODE 535. 009. 02 NOT COVERED UNDER E1B TITLE IIA CONSORTIUM CTLE CTLE Hours 6 ELL Hours 0 Pedagogy Yes/No Content Yes/No Follow your school district s procedures to register for workshops. FOR CERTIFICATE Year of DOB Last 4 Digits of SSN EMAIL ADDRESS WORK PHONE HOME PHONE S.D. ADMINISTRATOR S SIGNATURE DATE ALL...
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