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Used when the 504 Committee is conducting an Initial Evaluation to determine eligibility under the Texas Dyslexia Law together with 504 eligibility and for Periodic ReEvaluations (every three years) for Section 504-eligible students with dyslexia. Do not use Form 10 for Initial Evaluations or Re-Evaluations that include Texas Dyslexia Law eligibility considerations. Student: Grade: Referred by: Date of Referral: Campus: Student ID #: Date of Birth: Previous Campus: Position/Relation to.

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