Student Eligibility Verification
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Staff name *
Department of Submitter *
Which Six Weeks? *
Please list students by grade level that are eligible. *
Please list students by grade level that are ineligible. *
Please list students by grade level that are regaining eligibility. *
Signature *
Your signature on this form is stating that you have checked grades and all above information is correct, accurate, and up to date.
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