Epstein Secrets

Tardies O Check Homework O Encourage Reading at Home O Reinforce Skills O Attend Parent Conferences O Sign Daily/ treekly Notes K Attend Parent Curriculum/ Information Meetings 681 (REV. 8/12/2003) ORIGINAL - Cumulative Folder COPY • Te SIGMA! ant 0. r'AlteNT IGWNQAN er r-• •aren ua wan [Alt EFTA01709800 Studer! l

ve if additional space needed) C. LABORATORY (as indisated)., Hemoglobin /Hematocrit /cam • -6 NAM TITLE: ADORES (Please Print) Stool (0 & Tuberculin test: Sickle Cell ‘in Date 1ype -Fist date 7 / 34 1f results 9 OH 3040. 10196 (Riableces HRS44 Form 3040 which may ,(Stock Number. 5744-000-3

Tardies O Check Homework O Read with Child Every Night O Reinforce Skills O Attend Parent Conferences O Sign DailyNVeekly Notes O Attend Parent Curriculum/ Information Meetings DATE SIM 1523-n03 SIGNATURE OF TEACHER OATS PBSD teeT (REV. 9/13/2002) ORIGINAL - Cumulative Folder COPY - Teach 3/4/ EFTA01709981 THE SCHO

s I •• •r aM) (attach narrative if additional space needed) .:• C. LABORATORY (as indicated) • type Hernaglobin/Hematocrit Stool (O & PI Tuberculin lest " results dte Lead Sickle Cell NAME TITLE: ADDR (Pleas. NRS-N (Stock EFTA01709998 .ms 1%3 (344) OFFICE of VITAL STATISTICS CER

Itment/ContributIon Check all that appty. O Monitor Attendance / Tardles K Encourage Reading at Home O Attend Parent Conferences K Attend Parent Curriculum/ Information Meetings K Successfuly Remediated O Requires New AIP Next School Year O Successfully Remediated O Requires New AIP Next School Yew 1171S111/121SIIIINCE

Injur•es explain) (attach narrative if additional snipe needed) C. LABORATORY (as indicated) It. He-nOglobtrilklematocrit Stool 1O 8 P) d Tuberculin test. Lead Sickle tell r NAME: TITLE: ADDRESS: • (Please Print) A MRS -N Form 5040, Mar 91 (0bsotetes previous editions LIM Oat am