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DC Statewide Assessments Medical Exemptions Form
Directions: This form is to be used to verify, document, and approve the exemption of students during the statewide
assessment due to a medical emergency.
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How to fill out part i applicant information
01
To fill out Part I applicant information:
02
Start by writing your full legal name in the space provided.
03
Provide your current address including the street, city, state, and zip code.
04
Indicate your date of birth in the format of month, day, and year.
05
Specify your Social Security Number in the designated field.
06
If applicable, enter your Employer Identification Number (EIN).
07
Provide your primary phone number and email address.
08
Sign and date the form to verify the accuracy of the information provided.
Who needs part i applicant information?
01
Part I applicant information is required by any individual or organization that is requesting or initiating an application process. This includes employers, financial institutions, government agencies, educational institutions, and other entities involved in screening or evaluating applicants.
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What is part i applicant information?
Part I applicant information is a section of a form where the individual or entity applying for something provides their personal or organizational details.
Who is required to file part i applicant information?
The individual or entity applying for something is required to file Part I applicant information.
How to fill out part i applicant information?
Part I applicant information is typically filled out by entering personal details such as name, address, contact information, and any other information relevant to the application.
What is the purpose of part i applicant information?
The purpose of Part I applicant information is to identify and gather necessary information about the individual or entity applying for something.
What information must be reported on part i applicant information?
Information such as name, address, contact details, identification number, and any other relevant details must be reported on Part I applicant information.
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