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Get TN HS-1949 2011-2024

Ian ___ Black or African American ___ Native Hawaiian or Other Pacific Islander ___ White. Please see the definitions of Ethnicity and Race on the back of this application. FOR INSTITUTION USE ONLY: To identify the eligibility classification of the enrolled children identified above, please circle: Free, Reduced-Price or Paid. To identify the basis for classification, please circle: Categorically Eligible or Income Eligible Determining Official Signature: ________________________________________.

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