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\li320\ri0\sb600\nowidctlpar\wrapdefault\faauto\rin0\lin320\itap0\pararsid6304950 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 1}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid2390032 .}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 Name of School, Agency or Person(s): \par }\pard \ltrpar\ql \li360\ri0\sb1020\nowidctlpar\wrapdefault\faauto\rin0\lin360\itap0\pararsid4216763 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 2. R}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 ecords to be released}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763\charrsid4216763 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 / obtained}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 : \par }\pard \ltrpar\ql \li1397\ri4600\sb200\nowidctlpar\wrapdefault\faauto\rin4600\lin1397\itap0\pararsid12590545 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 {\field{\*\fldinst SYMBOL 114 \\f "Wingdings" \\s 11}{\fldrslt\f10\fs22}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 Academic Records }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid12590545 \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 {\field{\*\fldinst SYMBOL 114 \\f "Wingdings" \\s 11}{\fldrslt\f10\fs22}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032\charrsid874971 EST}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 notes }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid874971\charrsid12590545 \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 {\field{\*\fldinst SYMBOL 114 \\f "Wingdings" \\s 11}{\fldrslt\f10\fs22}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 IEP evaluation }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 \par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 {\field{\*\fldinst SYMBOL 114 \\f "Wingdings" \\s 11}{\fldrslt\f10\fs22}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 Behavioral checklists}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 \par }\pard \ltrpar\ql \li1397\ri70\sb200\nowidctlpar\tx8730\tx8800\wrapdefault\faauto\rin70\lin1397\itap0\pararsid12590545 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 {\field{\*\fldinst SYMBOL 114 \\f "Wingdin gs" \\s 11}{\fldrslt\f10\fs22}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 Previous comprehensive evaluations \par }\pard \ltrpar\ql \li1397\ri4600\sb200\nowidctlpar\wrapdefault\faauto\rin4600\lin1397\itap0\pararsid12590545 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 {\field{\*\fldinst SYMBOL 114 \\f "Wingdings" \\s 11}{\fldrslt\f10\fs22}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 Other \par }\pard \ltrpar\ql \li360\ri0\sb260\nowidctlpar\wrapdefault\faauto\rin0\lin360\itap0\pararsid4216763 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 3. The }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid2390032\charrsid6520746 purpose}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 (s) of the disclosure is}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 /}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 are:}{ \rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 \par \par \par _______________________________________________________ \par }\pard \ltrpar\ql \li2160\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin2160\itap0\pararsid4216763 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 Printed name \tab \tab \par }\pard \ltrpar\ql \li360\ri0\sb260\nowidctlpar\wrapdefault\faauto\rin0\lin360\itap0\pararsid4216763 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 _______________________________________}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14288131 _}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 ______}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14288131 ___}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 _________}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14288131 ______}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 ___________} {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid874971 \par }\pard \ltrpar\ql \li2160\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin2160\itap0\pararsid4216763 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 Signature}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14288131 \tab \tab }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 D}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 ate \par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f3\fs20\insrsid874971\charrsid4216763 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li734\ri202\sb240\nowidctlpar \jclisttab\tx740\wrapdefault\faauto\ls1\rin202\lin734\itap0\pararsid12590545 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid874971\charrsid4216763 If t}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid2390032\charrsid4216763 he dominant language of the home is other than English, this form must be completed in that language as well as in English.}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid12590545 \par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f3\fs20\insrsid2390032\charrsid4216763 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid2390032\charrsid4216763 Parent(s) may review the files upon request.}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid12590545 \par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f3\fs20\insrsid2390032\charrsid4216763 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid2390032\charrsid4216763 Parent(s) may have copies upon request. } {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid11351687\charrsid4216763 \par }\pard \ltrpar\ql \fi-900\li920\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin920\itap0\pararsid4216763 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4216763\charrsid4216763 \par }\pard \ltrpar\ql \fi-900\li920\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin920\itap0\pararsid12590545 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4216763 For}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2390032 questions please call: }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid2390032 _______}{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2390032 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid2390032 ______}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid14288131 __}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid2390032 ____}{ \rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14288131 _}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid2390032 ______}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid4216763 _________________ _________}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid12590545 ________}{ \rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \fs18\cf17\insrsid12590545 \par }\pard \ltrpar\ql \fi520\li3800\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin3800\itap0\pararsid12590545 {\rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \fs18\insrsid14288131\charrsid12590545 Name\tab \tab \tab }{\rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \fs18\insrsid12590545 \tab \tab }{\rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \fs18\insrsid14288131\charrsid12590545 tel.#}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf17\insrsid14288131\charrsid12590545 \par }}