(5$) OCR 51) ENTRY CO US I E01 (57) ENTRY OAT 08/14/01 MI GP IN 08 (59)CIL 01 ( CO) TEACHER NO (51) REASSIGN CODE KZ TRAKSPORTADDI 0 PBC Bus a D Pakn Tran 03)894114 VERF 1 2 3 4 51 (64) HAS A 0 Parent/Student Trans • Walk • Base 6 7 8 9T B 2 (65) Din arNTATION CITECKLIST (PHI

tion Checklist Transportation 0 Immunizations ID Binh Records Verification O Social Security Number 0 Physical Exams 0 Address Verifcatinri 0 PBC Bus 0 Palm Iran 0 Parent/Student Transpalation 0 Walk 0 Bike page 2 of 2 EFTA01709717 TEST RECORD INFORMATION PESO 0280 (REV. 7/15197) FRT EF