t address Local address City/state/zip lelephc Fax City/state/zip Telephone ( ) Fax ( SECTION B. Applicant's present school Telephone ) Current Grade ounse or s pnncipa s name Ed ratIn Grades/date attended Reason for leaving moved -to lq eGO Kirk. Previous Schools Attended (in reverse chron

ays Absent Telephone Principal_ School Name School Address Street N/A K N/A O NiA K PX No. City REGULAR INSTRUCTIONAL PROGRAM INFORMATION Current Grade Copy of Report Card Attached Instructional Materials (indicate level) GRADE I 2 3 a 5 PAGE Mathematics I 2 3 4 5 Macmillan O Reading