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Dd/yyyy): Toll Free # : Type of Visit: TWC Surveyor: School Contact: Title: This survey visit will consist of several parts: (1) an examination of the exhibits listed on the attachment; (2) a tour of the school facilities; (3) a review of requested documents; (only items 1-12 are required for ORIGINAL or MODIFICATION surveys); and (4) an inspection of other applicable items. Please refer to Page 3 for an explanation of abbreviations. STUDENT FILE REVIEW: (not required for Original or Modifi.

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