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receipt

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									                              NEW JERSEY CHARTER SCHOOL APPLICATION

APPENDIX G

                                 New Jersey Department of Education
                                 Receipt of Charter School Application


Name of Charter School: ________________________________________

Delivered To:_________________________________________________
County/District


Date:_____________________ Time:______________________________

Received By:__________________________________________________
Please Print Name and Title


Signature:_____________________________________________________




                                 New Jersey Department of Education
                                 Receipt of Charter School Application


Name of Charter School: _______________________________________

Delivered To:_________________________________________________
County/District


Date:_____________________ Time:_____________________________

Received By:_________________________________________________
Please Print Name and Title


Signature:____________________________________________________



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