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T RECENT EVALUATION: / / DATE OF NEXT REEVALUATION: / / PURPOSE OF CONFERENCE (Check all that apply) Review of Existing Data Reevaluation IEP Review/Revision Initial Eligibility Initial IEP Manifestation Determination Graduation Transition Termination of Placement Other (e.g. FBA/BIP) STUDENT IDENTIFICATION INFORMATION STUDENT S ADDRESS (Street, City, State, Zip Code) MALE ETHNICITY STUDENT S DATE OF BIRTH LANGUAGE/MODE OF COMMUNICATION USED.

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