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Form 4B - Report of Experience Record (Associate degree applicants only)

Applicants with associate degrees must complete Section I of this form and forward it to the appropriate supervisor for completion of Section II. Your supervisor must complete Section II and submit this form directly to the Office of the Professions at the mailing address at the end of the form. You may photocopy this form as needed to report the total amount of experience required. A Form 4B is not required for the "planned work experience" for which you submit a Form 4C.