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
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
Birth Certificate Verification