IHSCDEA Retiree Notification Form
To be recognized in the Pre-Conference issue of IDEA Journal, this form must be received by February 1st. To be just included in the program at the state conference, this form must be received by April 1st.
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What is your name as you want it to appear on the Certificate of Recognition? *
What IHSCDEA region are you retiring from? *
How many years have you taught? *
What is the name of the school where you have taught? (please spell it out) *
What is the school's street address? *
In what town is the school located? *
What is the school's zip code? *
What is the school's phone number? *
What is your home street address? *
What is name of the town in which you live? *
What is your zip code? *
What is your phone number? *
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