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Student & Agency Information

Continuing Education (CE) Credit

NOTE: Inaccurate completion of this section may forfeit you from CE credit.

Indicate your State of License. If you are in the process of becoming licensed, select the state you will be licensed in by the start of the program. If you will not be licensed, you must select the second option.

Shipping & Manager Information

Shipping Address - Where would you like your class materials sent?

Is your Agency appointed with The Hartford? *

YesNo

If appointed with The Hartford, enter your individual Producer Code and Agency's Mastercode below. If unknown, please contact your manager.