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ACT REGARDING THIS APPLICATION APPROVAL YEAR This application is JANUARY 1, 20_________ THROUGH DECEMBER 31, 20 __________ Original Approval Renewal of Previous Approval NAME OF SCHOOL CHIEF ADMINISTRATOR(S) (Include Title) MAIN OFFICE AND CLASSROOM ADDRESS STREET CITY COUNTY ZIP PHONE BRANCH OFFICE(S) AND CLASSROOM(S) ADDRESS STREET STREET CITY COUNTY CITY COUNTY ZIP CODE PHONE ZIP CODE PHONE SECTION A: CURRICULUM The following numbered exhibits must be attached to satisfy.

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