DOJ-OGR-00026510.jpg
DOJ-OGR-00026510.jpg
Why This Matters
The image displays a printed form titled "SPECIAL EDUCATION SERVICE CHECKLIST" with handwritten entries and corrections made by crossing out certain parts of the form in red ink.
AI-Generated Summary
The image displays a printed form titled "SPECIAL EDUCATION SERVICE CHECKLIST" with handwritten entries and corrections made by crossing out certain parts of the form in red ink. There are columns for dates, service codes, descriptions, and notes that have been filled in with various services such as Occupational Therapy and Speech-Language Pathology. The form also includes a section at the bottom labeled "REPORTING REQUIREMENTS" with boxes for signatures of the service provider and other staff members. The text on the document provides instructions related to the reporting of special education services provided by an organization, presumably in New York City, given the watermark or logo at the top right corner that reads "NYC Department of Education."
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