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El Other This page has been updated OV DATE: 4a97 a5- BY: DATE: PBSD 0269 (REV. 1/88) EFTA01709618 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C. LAST NAME PARENT OR GUARDIAN FIRST MI DOB MCYDAAR Child's SS# (optional)

school. Conference conducted (Indicate datets)) PBSD 0768 (Rev. 6/98) Goldenrod/1st Period Pink/2nd Period Canary/3rd Period Green/4th Period White/Office Copy EFTA01709615 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Grade Sh ELEMENTARY REPORT CARD Year 19 9 7 -19 9 8 Student Teacher MARKING CODES

Retain Mr Indicate: Promote (P) Retain (R) - Indicate: Promote (P) Retain (A) 01-93d0 EFTA01709793 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 64D-3.011, F.A.0 and s. 65C-22.006, F.A.C. LAST NAME J PARENT OR GUARDIAN D i r e t t i o n C • Enter all appropri

sent Days Tardy n 1 0 I Information Included V see- le' PLACEMENT * Goldonrod/let Ported Pink/2nd Porlod Canary/3rd Podod Green/4th Period White/Office Copy EFTA01709845 STUDENT PROFILE SHEET READING Instr. Level Scores a Yi i i.,, Sem. Yr.End Reading Running Record -•:•?1,.• ;y This ye

FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.03Z, 402.305, 402.313, Florida Statutes; rules 640-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code LAST N FIRST NAME MI

placement will be determined by the home school. PBSD 0768 (Rev. 7/99) Goldenrod/1st Period Pink/2nd Period Canary/3rd Period Green/4th Period White/Office Copy EFTA01710225 THE SCHOOL DISTRICT OF PALM BEACH COUNTY 2000- ort for Grades 1-5 Se DEM GRADE 2000-2001 ACADEMIC IMPROVEMENT PLAN STATUS

I PHYSICIAN OR CONIC NAME (PLEASE PRINT) JATELY IMMUNIZED AGAINST 'DANCE. -//,1/2,73 DATE EFTA01710101 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, a 10D-3.088, F.A.C. and S. 10M-12, F.A.C. ATE PARENT OR GUARDIAN FIRS I MI DOB moinAnta Child's 5Stt (optional) ST

placement Mil be determined by the borne school. PHD 0788 (Rev. 7/94) GoidenrodHst Period PInkJind Period Canary/3rd Period Greionflte Period White/Office Copy EFTA01710141 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary Student Transfer To Be Completed for All Transfers (Print or Type) LAST