About this Form
Form number: 560-40
Audience: School Staff
Last revised: January 2014
INSTRUCTIONS: Using the code definitions on the reverse side, complete for any student who resides in an out-of-county living arrangement. Supporting documentation should be copied and attached. If there are no students, check the box that says “There are no student(s) attending who fall under section 4-122.” Forward to: Reports Specialist, CESC, Room 11.
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