State of Connecticut
Department of Education

ALTERNATE  ADDRESS SUBMISSION FORM

for PORTFOLIOS SUBMITTED by May 15, 2008 ONLY
Use this form to provide an alternate address for portfolio score results.

Score results are mailed the first week of September.  By default they are sent to the district which is reporting your employment at that time.  If you wish your results sent to an alternate address complete the form below.

Please note, if you complete this form more than once, only the last entry will be considered valid.  Score results will not be sent to multiple addresses.  In the event that the information you provide on this form cannot be matched with a portfolio it will be considered invalid, and your results will be sent to your school address.

Also, please note, if you have changed your name since submitting your portfolio please use the name you were using when you submitted your portfolio.
First Name
Last Name
Address (line 1)
Address (line 2)   optional (apt, suite, building, et c.)
Town
State
Zip Code
Verification Please verify your request with the last four digits of your SSN.  This request must match the last name and portfolio id number of the portfolio you submitted.