Wisconsin Contact Information Form - Health Science Educators & HOSA Chapter Advisors
Instructions - Please complete this form if you are:
1) a NEW Health Science Educator and/or NEW HOSA Advisor OR
2) a CURRENT educator and/or HOSA Advisor and your contact information has changed.
This will allow you to be active on the Health Science Educator and HOSA Chapter Advisor contact distribution lists. Completing this form will provide you with communications regarding HOSA and Health Science Education information and events.
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First and Last Name
Position (select all that apply)
Health Science or Biomedical Sciences Educator (you teach at least one Health Science or Biomedical course)
HOSA Chapter Advisor
Educator License Area (select all that apply)
Experienced-based Licensure for Technical and Vocational Subjects – Healthcare-Related Occupations – DPI License Number 8011
Family and Consumer Science - DPI license numbers 1210, 1215, 1216
Health - DPI license number 1910
Science - DPI license numbers 1605, 1601
Business and Information Technology Education - DPI license numbers 1250, 1281
I am not a licensed educator
School Name (full name preferred)
School Mailing Address (street, city, zip code)
HOSA Chapter Name (if different from school name)
Please add me to the following contact lists (check all that apply).
Health Science Education - DPI Contact List
Wisconsin HOSA Contact List
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This form was created inside of Wisconsin Department of Public Instruction.