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Applicant Information Page Date Received by County Board of Education: Date Received by Institution of Higher Education: Social Security Number Birth Date (MMDDYYYY) Last Name Gender (M or F) US Citizen

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Anyone who is required to complete a questionnaire or form that includes a yes/no section needs to fill out the yes/no part. This can include individuals applying for permits, licenses, or certifications, as well as those providing responses to surveys or questionnaires.

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