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NCTASPA Job Fair Registration Form

First Name*

Last Name*

Address*

City*

State*

Zip*

Email*

Present Phone*

Permanent Phone*

University*

Certification State*

Enter your own if the Certification State is not in the U.S

Certification Level*

Elementary Middle School High School All Level

Certification Areas*

Certified Areas Not Selected		Selected Certified Areas

Other Certification Areas

(use this if your Certification Area was not listed above)