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Clark County School District Health Services Department9998500643CCF643 Rev. 12/07PARENT/GUARDIAN REQUEST FOR MEDICATION ASSISTANCE SCHOOL YEAR Name of Student (please print): Birthdate: Teacher:
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How to fill out 643 - req for
01
To fill out Form 643, follow these steps:
02
Start by entering your personal information, such as your name, address, phone number, and email address.
03
Provide details about the nature of the request and the purpose of the form.
04
Attach any supporting documents or evidence that may be required to support your request.
05
Review the completed form to ensure all information is accurate and complete.
06
Sign and date the form, indicating your agreement to the statements and information provided.
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Submit the form according to the instructions provided, either by mail, email, or through an online submission system.
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Keep a copy of the filled-out form for your records.
09
Follow up with the relevant authority or department to check the status of your request, if necessary.
Who needs 643 - req for?
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Form 643 - req is needed by individuals or organizations who are making a specific request to a government agency or department.
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It may be required for various purposes, such as requesting information, filing a claim, applying for a permit/license, or seeking a review of a decision.
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The specific requirements for Form 643 - req may vary depending on the agency or department you are submitting it to.
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It is advisable to check the official guidelines and instructions provided by the relevant authority to ensure the form is filled out correctly.
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