Chippewa Falls Area Unified School District
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Certified Staff Advance Degree &/or Additional
Licensure beyond Master’s in Priority Area Request
Name:
Grade Level:
Grade/Department:
Department:
Email Address:
Accredited University:
Enrollment Date:
Expected Graduation Date:
Degree/Award:
Major:
Minor:
Credits:
Will your degree add additional DPI licensure?

If yes, what license:

Attach Description of Program and Completion Requirements.

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