Epstein Secrets

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ALTH HISTORY (Serious Illnesses Inures explain) (attach narrative it additonal space needed) C. I ARARATARY Ina inelinlaelli e Tuberculin test Sickle Cell type date result NAME: TITLE: ADDRESS: (Please Print) r-rdl- OH 3040. 10116 (lieplooli 14R5-14 Form 3040 which easy be used) Mock Plumbot. 5

Grade Tested 10 Achievement Level NT FCAT Score • NT FCAT Score 3000 Reading 2500- 2000- 1500- 1000- S00- Grade 9 Grade et Grade Grade I GM* Gracie a Grade Grad 10' 11+ • Your Score O On Grade Level You did not score well enough to pass the Grade 10 FCAT Mathematics lest. Your Math

ir (attach narratrve if additional space needed) C. LABORATORY (a, indicate) Hempeiptyin/Hernatocrir Stool (O & P) Tuberculin test Leao Sickle Cell type date results NAME: FAMit y talee rtrn -ra TITLE: TV) P . CENTER Ntint atii J. ADDRESS: Royal Palm Beach, F/ 57) 7 95. 4773 (P

SHOULD SE AWARE OF, PLEASE LIST YOUR:.CIELDAENANIOINER latitEACH4gOUNTMSCHOOILSWSVSEKS•M-r: Sig,(4.:?ofp:n:w, ',/4M<Iti .;:fgft.tMita•c)fl . we4 (GM MAYEISI OF OAD0CNI (CS) SCHOOL ATTENDING (7C) STUDENT NO. (OPTIONAL) (711 GRADE O21 BIRTH DATE EFTA01710376 4 .14 - OOL Di's, \ 41 VERIFICATI

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