Complete ALL questions
Use a PEN (blue or black)…DO NOT ERASE
Put an “X” through incorrect information, write “Error” next to it, and fill in the correct response
When filling out choice boxes, place a check mark or diagonal line (/) in the box. Do not circle the box or just place a dot in the box – Teleform cannot read it.
Please print or write legibly
Fill in only ONE box per question unless it says, “Fill in all that apply”