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CES Hearing and Vision Request
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* Indicates required question
Email
*
Your email
Student last name, first name
*
Your answer
Homeroom Teacher Last Name
*
Your answer
Grade Level
*
4th Grade
5th Grade
Date screen is needed by:
*
MM
/
DD
/
YYYY
Parental consent has been obtained (4th grade only)
*
Yes
No
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