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Get and Sign Score Sheet Expanded Version 2008-2022 Form
Teacher Code:___ ___
Check type(s)
of disability:
Number of Staff present: ___ ___
Birthdates of children enrolled:
Number of children enrolled in class: ___ ___
Number of children present: ___ ___
physical/sensory
social/emotional
cognitive/language
other: _____________________
youngest __ __ / __ __ / __ __
m m d d
y y
oldest __ __ / __ __ / __ __
m m d d
y y
Time observation began: ___ ___ : ___ ___
AM
PM
Time observation ended: ___ ___ : ___ ___
AM
PM
Time interview began: ___...
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