NOTE: Reporting member information is kept confidential.

Please complete this survey every time you believe an unqualified person has been brought in to your school to supervise/teach a class.

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1. Your first and last name: (Required.)

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2. Your e-mail address: (Required.)

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3. School: (Required.)

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4. Name of teacher being replaced: (Required.)

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5. Date unqualified personnel observed in classroom: (Required.)

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6. Period of time unqualified personnel observed in school to supervise/teach a class: (Required.)

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7. Comments:

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