%PDF-1.6
%
1 0 obj
<> endobj
7 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[118.8 665.76 288.24 691.32]/Subtype/Widget/T(Students Name)/TU(Students Name)/Type/Annot>> endobj
12 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[431.16 665.76 540.36 691.32]/Subtype/Widget/T(Date of Birth mdy)/TU(Date of Birth \(m/d/y)/Type/Annot>> endobj
14 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[77.04 639.48 252.24 664.68]/Subtype/Widget/T(School)/TU(School)/Type/Annot>> endobj
16 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[319.08 639.84 353.64 664.68]/Subtype/Widget/T(Grade)/TU(Grade)/Type/Annot>> endobj
18 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[426.12 639.48 540.36 665.04]/Subtype/Widget/T(School Year)/TU(School Year)/Type/Annot>> endobj
20 0 obj
<>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 11 0 R
/Rect[36 366.12 45.96 372.6]/Subtype/Widget/T(students name and have the authority to make decisions on their behalf)/TU(students name\) and have the authority to make decisions on their behalf)/Type/Annot>> endobj
25 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[230.76 283.8 391.56 309.36]/Subtype/Widget/T(IWe give full and informed consent to)/TU(I/We give full and informed consent to)/Type/Annot>> endobj
27 0 obj
<>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 11 0 R
/Rect[36 284.64 45.96 291.12]/Subtype/Widget/T(service and that the team referral parentguardian consent and assessment report if completed will be uploaded in)/TU(service, and that the team referral, parent/guardian consent, and assessment report \(if completed\) will be uploaded in)/Type/Annot>> endobj
32 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[422.88 204.24 520.68 229.8]/Subtype/Widget/T(Date)/TU(Date)/Type/Annot>> endobj
34 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[422.88 177.72 520.68 203.28]/Subtype/Widget/T(Date_2)/TU(Date)/Type/Annot>> endobj
36 0 obj
<>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 11 0 R
/Rect[36 125.28 45.96 131.76]/Subtype/Widget/T(undefined)/TU(undefined)/Type/Annot>> endobj
41 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[158.52 124.44 342.24 149.64]/Subtype/Widget/T(IWe do not consent to)/TU(I/We do not consent to)/Type/Annot>> endobj
43 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[422.88 97.44 520.68 123]/Subtype/Widget/T(Date_3)/TU(Date)/Type/Annot>> endobj
45 0 obj
<>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 11 0 R
/Rect[422.88 70.92 520.68 96.48]/Subtype/Widget/T(Date_4)/TU(Date)/Type/Annot>> endobj
47 0 obj
<>/N<>>>/AS/Off/DA(/ZaDb 0 Tf 0 g)/F 4/FT/Btn/MK<>/P 11 0 R
/Rect[45.24 30.72 53.88 36.36]/Subtype/Widget/T(Copy Uploaded to TIENET Confidential File)/TU(Copy Uploaded to TIENET Confidential File)/Type/Annot>> endobj
52 0 obj
<>/P 11 0 R
/Rect[449.675 364.18 570.875 386.18]/Subtype/Widget/T(Text84)/Type/Annot>> endobj
53 0 obj
<>/P 11 0 R
/Rect[191.783 202.507 390.219 224.507]/Subtype/Widget/T(Text85)/Type/Annot>> endobj
54 0 obj
<>/P 11 0 R
/Rect[193.746 175.67 388.91 197.67]/Subtype/Widget/T(Text86)/Type/Annot>> endobj
55 0 obj
<>/P 11 0 R
/Rect[193.092 95.1606 388.91 117.161]/Subtype/Widget/T(Text87)/Type/Annot>> endobj
56 0 obj
<>/P 11 0 R
/Rect[193.746 68.9787 389.565 90.9787]/Subtype/Widget/T(Text88)/Type/Annot>> endobj
3 0 obj
<>/Font<>>>/Fields[ 7 0 R
12 0 R
14 0 R
16 0 R
18 0 R
20 0 R
25 0 R
27 0 R
32 0 R
34 0 R
36 0 R
41 0 R
43 0 R
45 0 R
47 0 R
52 0 R
53 0 R
54 0 R
55 0 R
56 0 R
]/SigFlags 0>> endobj
57 0 obj
<>stream
Microsoft Word
2025-03-03T15:58:10Z
2025-03-24T12:30:20-03:00
2025-03-24T12:30:20-03:00
uuid:945AEEB7-26D9-4309-92F8-3313456D68D7
uuid:d67b11be-8d10-0c42-9856-4bcfad041518
application/pdf
BCS Staff
1
1.1
endstream
endobj
2 0 obj
<>/Metadata 57 0 R
/Pages 58 0 R
/StructTreeRoot 59 0 R
/Type/Catalog/ViewerPreferences 60 0 R
>>
endobj
8 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
13 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
15 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
17 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
19 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
26 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
33 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
35 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
42 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
44 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
46 0 obj
<>/Subtype/Form/Type/XObject>>stream
/Tx BMC
EMC
endstream
endobj
61 0 obj
[ 7 0 R
12 0 R
14 0 R
16 0 R
18 0 R
20 0 R
25 0 R
27 0 R
32 0 R
34 0 R
36 0 R
41 0 R
43 0 R
45 0 R
47 0 R
52 0 R
53 0 R
54 0 R
55 0 R
56 0 R
] endobj
62 0 obj
<> endobj
66 0 obj
<> endobj
67 0 obj
<> endobj
69 0 obj
[0[646]1407[861]] endobj
65 0 obj
<> endobj
64 0 obj
[ 65 0 R
] endobj
70 0 obj
<>stream
x]Mj0>d&ʔ,C,ʲԘB6ﰨY=w'Ǹ-'༲ѵ²;$;j".78<0o=Mp:k8#%TۂQjf]cDi;
"©o.XdCjH
wjհ/>=Uq+);(ArOx[S1S o=
endstream
endobj
63 0 obj
<> endobj
74 0 obj
<>
endobj
75 0 obj
<>
endobj
73 0 obj
<>
endobj
72 0 obj
[ 73 0 R
]
endobj
78 0 obj
<>stream
H\j >w٤BJJ!i$cy
[ooMj偾;#:0(-fqQirA*w%4u8z0~
Giz<$:G8|5hXj0W>!(;2䕳尿W܄<9
#rI`P?`&U?obu,FE,"=$v&*5n2%Ot+o86YX mŹ8n9ZL*BPm
0 gp
endstream
endobj
71 0 obj
<>
endobj
82 0 obj
<> endobj
83 0 obj
<> endobj
85 0 obj
[0[778]3[250]11[333 333 500]15[250]17[250 278]20[500]29[278]36[722 667 667 722 611 556 722 722 333]47[611]49[722 722 556]53[667 556 611 722]58[944]60[722]66[500]68[444 500 444 500 444 333 500 500 278]78[500 278 778 500 500 500 500 333 389 278 500 500 722]92[500]182[333]404[604]] endobj
81 0 obj
<> endobj
80 0 obj
[ 81 0 R
] endobj
86 0 obj
<>stream
xeRn0>wH$DЇJ`/)R1!.y4ΌwžFִRhj8#&Z>q9
#tlz'Miè'؊}t+Olg~922&1Fz:`.ʖ0vFsc|M
Xاbx/`P]8gNң9R=p(X!BBkB1!z,
%:?ao])H-EjME㘂$O͇dP;[O-$}vJv+Z[ ץT*%
endstream
endobj
79 0 obj
<> endobj
88 0 obj
<> endobj
89 0 obj
[250 0 0 0 0 0 0 0 333 333 500 0 250 0 250 278 0 500 0 0 0 0 0 0 0 0 278 0 0 0 0 0 0 722 667 667 722 611 556 722 722 333 0 0 611 0 722 722 556 0 667 556 611 722 0 944 0 722 0 0 0 0 0 500 0 444 500 444 500 444 333 500 500 278 0 500 278 778 500 500 500 500 333 389 278 500 500 722 0 500] endobj
87 0 obj
<> endobj
91 0 obj
<> endobj
92 0 obj
[250 0 0 0 0 0 0 0 0 0 500 0 0 0 250 0 500 0 500 0 0 500 0 0 0 0 333 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 833 0 0 611 0 0 0 0 722 0 0 0 0 0 0 0 0 0 0 0 500 0 444 500 444 278 0 500 278 0 0 278 0 500 500 500 0 389 389 278 500 444 0 0 444] endobj
90 0 obj
<> endobj
94 0 obj
<> endobj
95 0 obj
[250 0 0 0 0 0 0 0 333 333 0 0 0 0 0 278 0 0 0 0 0 0 0 0 0 0 333 0 0 0 0 0 0 0 0 0 0 0 0 778 0 0 0 0 667 0 0 778 611 0 722 0 667 0 0 0 0 0 0 0 0 0 0 0 0 500 0 444 556 444 0 500 556 278 0 0 278 833 556 500 556 0 444 389 333 556 0 0 0 500] endobj
93 0 obj
<> endobj
96 0 obj
<>stream
JFIF ` ` C
$.' ",#(7),01444'9=82<.342 C
2!!22222222222222222222222222222222222222222222222222 R"
} !1AQa"q2#BR$3br
%&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz
w !1AQaq"2B #3Rbr
$4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? dGM$2
%8by$`1 _;|G?d4=.6e83{V:ȉA]3kiGۅxn漧VaͪgY۟,˚ޕo֯go;mYzq
jNƛOwgcuu;cTE{o4}eGW|A?Ky6ap=k?)5/R&G̥ܿұw&Z2$Nz[_:㨐aLbQ=GҾWmngVht8 ֕pИWqvg٢4M~5XW=Ez%y;c%%tQIRPʣ,@&KijO7pk>#xVdGmbVO֛sd wesJA)W_8t* $sjdz!.Z{J.{n5]>M?^@
amlor)1$2$z2MJ|.IVRT0M*Fl
V_gqwFy;0j^j~ʷTK \3^Q˫KؗM#FU@ώG5H90r"Ut{7P0ʺ0
K\_5;/7ڮtyy>4$9Zk2 &uPGoMxip%ݕ3J[UN3]m5K/7
53!b ^|zպQIh=rPgu
8`Vkɾ
]Ak.f$Qzݵy2yVs4<wUQԱV-_M_*w &wE)"Dp:P3L.1'piXw,P[^^CO܌[XVo%턙(;1]h09((((((((((((&42-M݂g #kkύ;DP