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O. Box 1810 Marion IN 46952 Fax 800 403-0864 Page 1 of 2 Social Security number XXX-XXI. ENROLLMENT Name of school The student attends The student is enrolled in Less than half time Half time or more Full time A graduate program An undergraduate program If No in student s curriculum Is a GED or diploma required for enrollment in school Yes No II. Reset Form Date month day year REQUEST FOR STUDENT INCOME AND EXPENSES State Form 42755 R9 / 7-17 FAMILY AND SOCIAL SERVICES ADMINISTRATION NOTICE...

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