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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
Diagnostic Software El Other (see attached) gtenter Sense. Concepts and aeons cement aY ac Thinking ata Analysis and Probability O Reading in Content Area Specific Concepts arsodbook Assessments K Porddio w Perfamance Assessments FCAT DlagnostidPractice Tests ID Diagnostic Software O Other (see e
••• --._.. .P.tyar•.b= fietv: EFTA01709855 EFTA01709856 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402305, 402.313, Florida Statutes; s 64D-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code Fl T NAME MI CHILD'S SS#
rrative O Expository K Persuasive mber Sense, Concepts and rations effeasurement metry eb is Thinking D Analysis and Probability eacfing in Content Area Specific Concepts O The Nature of Matter • Energy O Force and Motion O Processes that Shape the Earth O Earth and Space DI Processes et Life
be between 1750 and 1856. NT-Not Tested NR-Not Reported Data Run Date: 11/22/2004 0115263 EFTA01710024 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032,8.64D-3.011, F.A.0 ands. 65C-22.00C F.A.C. FIRST Child'sSW (optional) MIAR IM DO MO/DA/YR STATEIMMUNIZATION ID#' Dire
t ji‘mber Sense, Concepts and epaPerasatiums remen. t metry 9Alec gebraic Thinking O/9a,u Analysis and Probability ProbabilityDi D./Reacting In Content Area Spec& Concepts O ■• K K O (3 The Nature of Matter Energy Force and Motion Processes that Shape the Earth Earth and Space Processes of if
(46f DATA ENTRY COMPLETED BY DATE S/ DATE PBSD 0636 (REV. 4/6/20015.29/2001) page 2 of 2 EFTA01710389 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 Directions: • Enter all appropriate doses and
at Shape the Earth K Earth and Space Processes of Lie How Living Things Intend with Mel Environment K The Nature of Science concepts Reading it Content Area Specific Concepts N O a N Fe d gI wing ng Schad Day After/Before School /Saturday instructional Artematives O Temporary Skill Groups O Coop
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
Earth O Earth and Space O Processes of Lite [ How Living Things Interact with their Environment O The Nature of Science concepts O Reading in Content Area Specific Concepts Tutoring K During Smoot Day O After/Before School / Saturday Instructional Alternatives El Temporary Skill Groups O Cooperat
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