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Birth Certificate Verification by undul846

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									BIRTH CERTIFICATE VERIFICATION
District: Building/ Program: School Year: Count Day: 2007-2008 September February

I certify that this is a true and accurate account of the follow-up conducted.

Authorized Representative's Signature

Title of Authorized Respresentative

Date

INSTRUCTIONS:
First Name Last Name

Complete the following information to document follow-up conducted for pupils not presenting birth certificate at time of enrollment. You also need to include any student that you don't have a birth certificate in their CA-60 on this list. Grade Date Seen Type of Verification Seen by Whom Audited

1/10/2010

11:24 PM

Birth Certificate Verification

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