SCHOOL NO EMPLOYEE NO 9 / 6 STUDENT CASE MANAGEMENT STUDENT SERVICES FORM 8 J EMPLOYEE NAME S/ 1. 04 / 7-S COMPUTER RECORDED STUDENT ID Ig1T COMMENTS: REFERRED BY: 878.2184 STUDENT NAME 7 4 7 CA/SECT 3 1,) lam.ceCvi SCM# DATE SERVICE TIME CODE Mo. Day Yr. (Military/ /01 Ot r7S/ Keea2-25/ r-g // I /2-IV Hay 3 19 198 /1:eo 3 /2.4 o3 c7SP //X 3 04 O/ 1/1( /5706 o2 - Ry Z(30 /1 I o'fQ rev C. // I -13 °tote V WitiE - for 04[4:irgr..a4 .r.1„tia in;I14: :00;:gols ofittr . ; ,1141.Z. To AdanNlralor FM-3673 REV. (04-87) COMMENTS: c -e = D— //0 2 - 27e7ice-, 414t-e eon c~1 Gyp Cdej, fT/2 - /4-urrzta-) - , 566:_ef aiA/a4-€ fir) Ictir 7z 3 . ni?e- 11-1)64,1 i/tice,,, (;77ea- 2 /erflnrcee-el , /4,-;.?17 CS7s 878.2164 01011E • for °'''InZ,°.'1:647.0,Irnr;="141,ct";.7.=1::r10•TO 1 "°"-- CONFIDENTIAL FM.3673 REV. (04-87) 3501.160-080 Page I of I EFTA 00069571 EFTA01247282