_______________________________________ Title I Director/Coordinator’s Signature _______________________________________ Date _______________________________________ Administrator’s Signature _______________________________________ Date TITLE I PAGE 1 Rev. Section 1113(a)(5) Evidence Sources: Verified: [ ] Economic survey data or [ ] Yes [ ] Ranked master list of schools [ ] No [ ] Other (specify)___________________________________________ TITLE I Page 2 Rev. 4-5 Evidence Sources: Verified: [ ] Documentation of non-Title I use [ ] Yes [ ] Other (specify)___________________________________________ [ ] No [ ] N/A TITLE I Page 17 Rev. Section 1116(b)(1)(A) Evidence Sources: Verified: [ ] ...
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