Contact information

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Contact information

Please fill out the following form to request a copy of your 2024 1095-C Tax form

School District *

Name *

Last 4 of Employee's (or retiree) Social Security Number *

Email *

Street Address *

City *

State *

Zip Code *

Phone number (for questions) *

Method of distribution *

Hard Copy (mail to address provided)

Email Copy (use email provided)

Authorization *

By clicking this box, you are agreeing to receive your 1095-C form within 30 days by the method selected above

Required

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