CONNECTICUT DEPARTMENT OF LABOR .ct.us
Please return your completed form with the documentation requested below by mail or fax to (860) 263-6768. If mailing, return to: CT Dept. of Labor, Office of Program Policy, 200 Folly Brook Blvd., Wethersfield, CT 06109. CLAIMANT INFORMATION Claimant’s name: Social security number: Name of school or training facility: Address: Program ................
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