1. Verification of a Highly Qualified Subject Area Content Test
  2. To The State Education Agency or School District NCLB Officer:
      1. RETURN FORM TO:

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Verification of a Highly Qualified
Subject Area Content Test
Fill in the information above the broken line. Please print or type.
last name
first name
middle name
maiden name
street address
city
state
zip code
social security number
date of birth (month, day, year)

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To The State Education Agency or School District NCLB Officer:
Please complete the information below that applies to the above-named Florida teacher and
return the form to the Florida School District Certification Office as indicated below.
The applicant is highly qualified in _________________________________________________
[subject area(s) & level(s)]
_______________________________________________based on having passed a subject area
content test appropriate for each subject area indicated.
Verifying Officer & Title (please print)
?
Signature
?
State
?
Date
?
RETURN FORM TO:
Florida School District Certification Officer
?
School District
?
Address
City, State, Zip Code

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