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La59432
La59432
Candidate Data:
First Name: 
Mason
Last Name: 
Lanpher

Date of Birth:

Age:

8

-

27

-

2010

11

School:

Keene Middle School

Grade:

6

Guardian Info:

First Name:

Dakota

Last Name:

Lanpher

Address:

18 Pearl Street Apt. 1

Keene

NH 

03431

Guardian/Family Phone:

Guardian/Family Email Address:

Living Situation:

Dad w/ live-in girlfriend

Financial Situation:

Medicaid:

Yes

Free/Reduced Lunch:

Yes

TANF:

Yes

SNAP:

Yes

How many live in the household?

-6

How many work and/or provide income to support the household?

0

Household Situation:

Organizations / Mentor Programs:

Special Assistance:

Health Concerns:

Victim of Sexual Abuse:

Perpetrator of Sexual Abuse:

Victim of Physical Abuse:

Threatening or Aggressive Behavior:

Required Physical Restraint:

Personality / Social Standing:

Behavioral Patterns:

Remarks: