2011-2012 FR application part 2x-2025

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  1. Click ‘Get Form’ to open the 2011-2012 FR application part 2x in the editor.
  2. Begin by reviewing the first section regarding sharing information with Medicaid/SCHIP. If you do not wish to share your information, check the 'No' box and fill in your child's name and school details in the provided fields.
  3. If you agree to share your information, check the appropriate 'Yes' boxes for each program listed. Ensure you fill out the child’s name and school for each entry.
  4. Complete the signature section by signing as a parent/guardian, entering the date, and providing your printed name and address.
  5. Once all fields are filled out accurately, save your changes. You can then download or send the completed form directly from our platform.

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