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Thank you for taking the time to share this important information. Please provide the following information for all New Teachers (teachers in their first and second years of teaching) hired.
Please provide your school information:

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* 1. Please Provide Area:

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* 2. School Name:

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* 3. School City

Please provide your new teacher's contact information below:
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* 4. First Name:

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* 5. Middle Name:

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* 6. Last Name:

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* 7. Maiden Name, if married: (We ask this in case their license is in their maiden name.)

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* 8. School Email Address:

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* 9. Personal Email Address:

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* 10. Teacher Cell or Home Phone Number with Area Code:

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* 11. Is teacher in the first or second year of teaching?

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* 12. Teaching assignment:

Please provide the Teacher's licensure information (can be obtained by going to https://elo.wieducatorlicensing.org/datamart/publicSearchMenu.do)

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* 13. 6-digit DPI License Number:

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* 14. License Expiration Date:

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* 15. Type of License (New Teacher, Professional Educator, Substitute)

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* 16. Please list any stipulations.

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* 17. If this teacher does not have a Wisconsin Teaching License, please explain the reason/s and inform if he/she has applied for a license or when he/she plans to apply.

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* 18. If this teacher is a Second-Year Teacher, was he/she provided a Mentor during the first year of teaching?

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* 19. If this new teacher is replacing another teacher at  your school please provide the teacher's name.

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* 20. Has this teacher left your school?  If yes, please give us the reason/s for departure.

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* 21. If this teacher has not left your school, has he/she been reassigned?  If yes, to what position?

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