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:

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* 2. Your e-mail address:

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* 3. School:

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* 4. Name of teacher being replaced:

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* 5. Date unqualified personnel observed in classroom:

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

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* 7. Comments:

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