Student Reporting Form

C.              FACSIMILE:  STUD – STUDENT ENTITLEMENT

COMM                          STUDENT ENTITLEMENT                     STUD

[1-D]                             [2-D]                               [3-D] 

NH: SSSSSSSSS SSSSS SSSSSSSSS    BN: SSSSSSSSS SSSSS SSSSSSSSS      PIC: SSS

[4-M]

PERSONAL CONTACT WITH STUDENT MADE/ATTEMPTED (M/A): X

[5-M]

BEGIN FULL TIME ATTENDANCE (MMCCYY): 999999

[6-M]

END FULL TIME ATTENDANCE (MMCCYY): 999999

[7-C]

IF AGE 19 ATTAINMENT MONTH PRIOR TO END FTA, ENTER SCHOOL OPERATING BASIS: 9

         1=YEARLY

         2=QUARTERLY/SEMESTER – NO REENROLLMENT REQUIRED

         3=QUARTERLY/SEMESTER – REENROLLMENT REQUIRED

[8-O]

HIGH SCHOOL GRADUATION MONTH (MMCCYY): 999999

[9-C]

FULL TIME ATTENDANCE AFTER GRADUATION BUT BEFORE AGE 19 (Y/N): X

[10-O]

MONTH OF LAST FULL TIME ATTENDANCE (MMCCYY): 999999

[11-O]

CHANGE IN INTENT MONTH – DEEMEND ATTENDANCE PERIOD INVOLVED (MMCCYY): 999999 

[12-C]

ENTER CHANGE IN INTENT INDICATOR: 9

1=ACTUAL DATE  2=NOTIFICATION DATE  3=NEW SCHOOL YEAR START DATE.

[13-O]

REMARKS: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

[14-O]

DELETE THIS OCCURRENCE OF DATA (Y/N): X

[15-O]                                   [16-O]

ADD NEW OCCURRENCE (Y/N): X              REVIEW PRIOR OCCURRENCES (Y/N): X

[17-D]                                                       [18-O]

PF1 HELP AVAILABLE                                           TRANSFER TO: XXXX