Epstein Secrets

1 - Inadequate effort and participation: parent conference requested FINE ARTS REPORT Marking Period 1st 2nd 3rd 4th 3 3 Art Music _3 33 Physical Education 3 3 ,3 School _ Principal SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS Please work on the area(s) that have a check (I). Marking Period 1st 2nd

sician or Clinic Name: (Print or stamp) Address: Expiration Date: (15 days after ant inuntuthafteei appointment) hvsician or ignature: Date: Permanent Medical Exemption PART C For medically contraindicated immun exemption: DOE Code 3 tions, list each vaccine and state valid clinical reasoning or evidence for I ce

s A a- Aci- ,81" Ertl C Science / 5 5 S *Sri— ,r4 Health 4, a a- a- /7- Music 5. 5 sst- ,..5.4 5 II- ...0-: Art 5 SI- ,54- S )e--- .5/— Physical Education 5 5 -.5' S. C f Promoted or Retained Teacher 2 4, (7‘ EFTA01710052 Elementary Test Record Student CTBS/4 FORM/ LEVEL A-11 GRADE • 1.

Clinic Name: Expiration Date: (Print or sump) (15 days after next immunization appointment) Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 - -

ng Handwriting/Penmanship Social Studies Science/Health Grades not given this nine week FINE ARTS REPORT Art Music Marking Period 1121EIMES Physical Education PARENT/GUARDIAN/TEACHER CONFERENCE Conference conducted (Indicate date(s)) Marking Period 1st 12nd 3rd 4th Grade (.5 Year 2000-2001 SOCIAL

ic Name: 05•days after next immuilization.appoiutrnent) (Print or stamp) . . _ . . . • Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I c

s A a- Aci- ,81" Ertl C Science / 5 5 S *Sri— ,r4 Health 4, a a- a- /7- Music 5. 5 sst- ,..5.4 5 II- ...0-: Art 5 SI- ,54- S )e--- .5/— Physical Education 5 5 -.5' S. C f Promoted or Retained Teacher 2 4, (7‘ EFTA01727105 Elementary Test Record Student CTBS/4 FORM/ LEVEL A-11 GRADE • 1.

Clinic Name: Expiration Date: (Print or sump) (15 days after next immunization appointment) Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 - -