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MEDICAL REQUEST FOR HOUSEBOUND ATTACHMENT 3 (PAGE 1) Scott County Public Schools 340 East Jackson St. Gate City, Virginia 24251 276-386-6118 FAX 276-386-2684 Student Name: Date of Birth: Address:
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Attachment 3 page 1 is a form used for reporting specific financial information.
Individuals or entities with certain financial transactions may be required to file attachment 3 page 1.
Attachment 3 page 1 should be filled out accurately and completely with the required financial information.
The purpose of attachment 3 page 1 is to provide detailed financial information for reporting purposes.
Information such as income, expenses, assets, and liabilities may need to be reported on attachment 3 page 1.
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