State of Connecticut
Department of Education

HOME  ADDRESS SUBMISSION FORM

for PORTFOLIOS SUBMITTED for May, 2009 ONLY

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Use this form to provide your home address for portfolio results.

Portfolio performance results are mailed as soon as they are available.  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.  Portfolio performance 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.