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Student Data Information Sheet

Name: _____________________
Parent(s): ___________________
___________________
Address: ____________________
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Phone Number(s):
Home: _______________________
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Work: _______________________
Cell:_________________________

DOB:________

MCT2 Test Scores 10/11


Math-______________
LA-________________
Writing-____________
Class Schedule:
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2.___________________
3.___________________
4.___________________
5.___________________
6.___________________
7.___________________
8.___________________

IEP:_________ Eligibility: _________ Ruling:_______

DOCUMENTATION:
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