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Get IA Score Sheet - Expanded Version

___ ___ ___ Date of Observation: __ __ / __ __ / __ __ Center/School: _______________________________ Center Code: ___ ___ ___ Number of children with identified disabilities: ___ ___ Room: ______________________________________ Room Code: ___ ___ Check type(s) of disability: □ physical/sensory □ social/emotional Teacher(s): ___________________________________ Teacher Code: ___ ___ m m d d y y □ cognitive/language □ other:___________________ Birthdates of children enrolled:.

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