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Getting Involved
The Role | A Day in the Life | Qualifications | FAQ's |Interest Form|Profile Form

Linking Agent Interest Form
Name of Candidate:
Address of Candidate:
City: State: Zip:
Telephone: Fax:
E-mail:
School District:
School District Website:
Mailing Address:
City: State: Zip:
Telephone: Fax:
E-mail:

Access to e-mail:

Access to Internet:

Support of Director/Coordinator of Special Ed:

Will you need Continuing Education Units (CEUs)?

For what organization/agency do you need these?
This form will be electronically E-mail by pressing "Submit" or you can print it out and fax it to EMSTAC at (202) 944-5408, attention Judy Shanley. Thank you for your Interest.
 
EMSTAC
1000 Thomas Jefferson St., NW
Suite 400
Washington, DC 20007 		Tel: (202) 944-5300
TTY: 1-877-334-3499
Fax: (202) 944-5454