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903
903
Candidate Data:
First Name:
John
Last Name:
Smith
Date of Birth:
Age:
01
-
01
-
1969
10
School:
ABC School
Grade:
5th
Guardian Info:
First Name:
Mommy
Last Name:
Smith
Address:
123 Street
Manchester
NH
03103
Guardian/Family Phone:
Guardian/Family Email Address:
Living Situation:
Single Mother
Financial Situation:
Medicaid:
Free/Reduced Lunch:
TANF:
SNAP:
How many live in the household?
2
How many work and/or provide income to support the household?
0
Household Situation:
Test.
Organizations / Mentor Programs:
Test.
Special Assistance:
Test.
Health Concerns:
Test.
Victim of Sexual Abuse:
Test.
Perpetrator of Sexual Abuse:
Test.
Victim of Physical Abuse:
Test.
Threatening or Aggressive Behavior:
Test.
Required Physical Restraint:
Test.
Personality / Social Standing:
Test.
Behavioral Patterns:
Test.
Remarks:
Test.
