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Get SSA-5666 2004

RMATION Please ask the person(s) most familiar with the child's records to complete this form. Continue any answers as needed on next page. Name of School 1. Has there been any recent evaluation or testing of this child? If yes, kind(s) of test/evaluation: Date(s): Please send us copies of all comprehensive evaluations, triennial assessments, psychological or speech/language testing, current Individualized Education Programs, teacher/therapist progress reports, and all other records that can .

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